Provider Demographics
NPI:1871288761
Name:JAMES-HAYNES, KELLY-ANN M (LMSW-20069)
Entity type:Individual
Prefix:
First Name:KELLY-ANN
Middle Name:M
Last Name:JAMES-HAYNES
Suffix:
Gender:F
Credentials:LMSW-20069
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 TOWNE CENTRE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3598
Mailing Address - Country:US
Mailing Address - Phone:443-646-3907
Mailing Address - Fax:
Practice Address - Street 1:1910 TOWNE CENTRE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3598
Practice Address - Country:US
Practice Address - Phone:443-646-3907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLMSW200691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical