Healthcare Provider Details

I. General information

NPI: 1184575698
Provider Name (Legal Business Name): MIA HAYNES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9220 MENTOR AVE
MENTOR OH
44060-6412
US

IV. Provider business mailing address

5938 STUMPH RD APT 4
PARMA OH
44130-1715
US

V. Phone/Fax

Practice location:
  • Phone: 440-255-1700
  • Fax:
Mailing address:
  • Phone: 440-255-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: