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General NPI Number Information
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NPI Number | 1902093347
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Entity Type | Individual
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Provider Name | SHERI HAINES MA, LPC, LICDC
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Gender | Female
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 10/01/2007
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Provider Practice Location Address
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Address Line | 904 SCIOTO ST COMMUNITY MERCY REACH
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City | URBANA
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State | OH
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Zip | 43078
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Country | US
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Telephone | 937-653-3001
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Fax | 937-484-6186
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Provider Business Mailing Address
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Address Line | 904 SCIOTO ST COMMUNITY MERCY REACH
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City | URBANA
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State | OH
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Zip | 43078
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Country | US
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Telephone | 937-653-3001
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Fax | 937-484-6186
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 011139
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | C 0004980
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License Number State | OH
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