Sally Ironside Haynes, LMHC, MAC, EMDR CERT

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

19409 Issued in NC

Practice address

611 Sullivan Rd
Statesville, NC 28677-3437

Phone

(704) 762-7400

NPI assigned

Jun 15, 2012

Last updated

Mar 11, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Baker Counseling Center LLC

  • Professional Counselor
  • Statesville, NC
  • NPI 1609320332

  Addiction (Substance Use Disorder)

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1339718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710115200000",
    "number": "1669734539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5685",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286875685",
            "telephone_number": "704-762-7400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 SULLIVAN RD",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286773437",
            "telephone_number": "704-762-7400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAYNES",
        "first_name": "SALLY",
        "middle_name": "IRONSIDE",
        "name_prefix": "Ms.",
        "credential": "LMHC, MAC, EMDR CERT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-15",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "FL",
            "license": "29553",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "19409",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leslie Lenore Hatfield, RDH
• Patricia Louise Hatfield, NP
• Roger Roshan Hatharasinghe, M.D.
• Barbara Jo Hayes, FNP
• Ishmael Robert Hayfron, DNP, FNP-C
• Susan Blackwelder Haynes, LCASA
• Renee M Hazelton, PA-C
• Alyssa English Head, PHYSICIAN ASSISTANT
• Claire Head, OD
• Maria Campbell Head, FNP-C

• Professional Counselor in Statesville, NC
• Providers in Statesville, NC by specialty
• Professional Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.