Provider Demographics
NPI:1902093347
Name:HAINES, SHERI (MA, LPC, LICDC)
Entity Type:Individual
Prefix:
First Name:SHERI
Middle Name:
Last Name:HAINES
Suffix:
Gender:F
Credentials:MA, LPC, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 SCIOTO ST
Mailing Address - Street 2:COMMUNITY MERCY REACH
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078
Mailing Address - Country:US
Mailing Address - Phone:937-653-3001
Mailing Address - Fax:937-484-6186
Practice Address - Street 1:904 SCIOTO ST
Practice Address - Street 2:COMMUNITY MERCY REACH
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078
Practice Address - Country:US
Practice Address - Phone:937-653-3001
Practice Address - Fax:937-484-6186
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH011139101YA0400X
OHC 0004980104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker