Provider Demographics
NPI:1831438183
Name:HAINES, VIRGINIA S (LISW-S)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:S
Last Name:HAINES
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:S
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:VIRGINIA WILSON LISW
Mailing Address - Street 1:14 SANDALWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-9233
Mailing Address - Country:US
Mailing Address - Phone:740-788-8850
Mailing Address - Fax:740-788-3424
Practice Address - Street 1:14 SANDALWOOD DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-9233
Practice Address - Country:US
Practice Address - Phone:740-788-8850
Practice Address - Fax:740-788-3424
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.17007261041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker