Healthcare Provider Details

I. General information

NPI: 1750859591
Provider Name (Legal Business Name): TIFFANY M HAYNES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2018
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 HAMAKER CT STE 450
FAIRFAX VA
22031-2237
US

IV. Provider business mailing address

3025 HAMAKER CT STE 450
FAIRFAX VA
22031-2237
US

V. Phone/Fax

Practice location:
  • Phone: 240-800-5772
  • Fax:
Mailing address:
  • Phone: 240-800-5772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701012189
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number16451
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC12210
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: