Provider Demographics
NPI:1437326675
Name:HAINES, ALFREDA (LMHC, SAP SUDP, CPC)
Entity type:Individual
Prefix:
First Name:ALFREDA
Middle Name:
Last Name:HAINES
Suffix:
Gender:F
Credentials:LMHC, SAP SUDP, CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 PACIFIC AVE STE 213-214
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-4446
Mailing Address - Country:US
Mailing Address - Phone:253-777-4772
Mailing Address - Fax:253-883-3572
Practice Address - Street 1:917 PACIFIC AVE STE 211-214
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4446
Practice Address - Country:US
Practice Address - Phone:253-777-4772
Practice Address - Fax:253-883-3572
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101Y00000X, 175T00000X
WACP00006433101YA0400X
WALH60233720101YM0800X
WANCC 259424101YP2500X
WANCC259424101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2024025Medicaid