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1972053205
ANTHONY HAYNES
ROSEBURG, OR
NPI
1972053205
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor Addiction (Substance Use Disorder)
(Licence: OR 13-12-59)
Enumeration Date
2016-10-11
Last Update Date
2016-10-11
Business Address
ANTHONY HAYNES
2575 NW KLINE ST
ROSEBURG, OR 97471-8827
Phone number: 541-673-3504
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Mailing Address
ANTHONY HAYNES
2575 NW KLINE ST
ROSEBURG, OR 97471-8827
Phone number: 541-673-3504
Copy
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