MEDICARE: MRS. JENNY M. HAINES ED.S., ABD

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	101YP2500X	Professional Counselor	6740	NC

General Provider Information

NPI Number	:	1164684650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNY M. HAINES ED.S., ABD

Provider Business Mailing Address
First Line	:	3536 CAMERON CREEK DR
Second Line	:
City	:	MATTHEWS
State	:	NC
Zip	:	28105-6880
Country	:	US
Telephone Number	:	704-280-4707
Fax Number	:

Provider Business Practice Location Address
First Line	:	5113 PIPER STATION DR
Second Line	:	SUITE 207
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-6689
Country	:	US
Telephone Number	:	704-541-0424
Fax Number	:	704-541-4244

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2008
Last Update Date	:	06/26/2008

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