MEDICARE: CAROLYN BRENNAN HAINES, PH.D., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	8472	MA
2	305R00000X	Preferred Provider Organization	3509	NC

General Provider Information

NPI Number	:	1093764128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLYN BRENNAN HAINES, PH.D., P.C.

Provider Business Mailing Address
First Line	:	1112 CROSSWAY LN
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-6855
Country	:	US
Telephone Number	:	919-285-4584
Fax Number	:

Provider Business Practice Location Address
First Line	:	1112 CROSSWAY LN
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-6855
Country	:	US
Telephone Number	:	919-285-4584
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CAROLYN BRENNAN HAINES
Credential	:	PH.D.
Telephone Number	:	919-285-4594

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	04/15/2008

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