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General NPI Number Information
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NPI Number | 1912465352
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Entity Type | Individual
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Provider Name | DANIELLE HAINES
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Gender | Female
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Dates
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Enumeration Date | 03/05/2019
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Last Update Date | 03/05/2019
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Provider Practice Location Address
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Address Line | 2444 COMMERCE RD STE 215
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City | JACKSONVILLE
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State | NC
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Zip | 28546-7560
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Country | US
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Telephone | 615-294-1221
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Fax | 910-327-2716
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Provider Business Mailing Address
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Address Line | 11406 LYNDENWOOD CT
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City | CHESTERFIELD
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State | VA
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Zip | 23838-5263
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Country | US
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Telephone | 615-294-1221
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Fax |
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-19-80355
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License Number State | FL
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