Active NPI
Thomas Lee Haynie, CDCA
- Addiction (Substance Use Disorder) Counselor
- Lorain, OH
National Provider Identifier
1902467756
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- CDCA.166486
- Practice address
- 6150 Park Square Dr Ste B
Lorain, OH 44053-4153 - Phone
- (440) 984-3882
- NPI assigned
- Jun 24, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | CDCA.166486 | OH | Primary |
Addresses
Primary practice location
6150 Park Square Dr Ste B
Lorain, OH 44053-4153
Mailing address
1925 Hayes Ave
Sandusky, OH 44870-4737
Phone (419) 557-5177
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CDCA.166486 | OH | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1561334400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1592179200000",
"number": "1902467756",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1925 HAYES AVE",
"city": "SANDUSKY",
"state": "OH",
"postal_code": "448704737",
"telephone_number": "419-557-5177"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6150 PARK SQUARE DR STE B",
"city": "LORAIN",
"state": "OH",
"postal_code": "440534153",
"telephone_number": "440-984-3882"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAYNIE",
"first_name": "THOMAS",
"middle_name": "LEE",
"credential": "CDCA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-06-24",
"last_updated": "2020-06-15",
"certification_date": "2020-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OH",
"license": "CDCA.166486",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lorain, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.