Individual
SUSAN BLACKWELDER HAYNES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCASA
Contact information
Practice address
636 SIGNAL HILL DRIVE EXT, STATESVILLE, NC 28625-4774
(704) 871-2992
(704) 871-2994
Mailing address
515 CLANTON RD, CHARLOTTE, NC 28217-1309
(704) 332-9001
(704) 714-1182
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
01/29/2013
Last updated
01/29/2013
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