Provider Demographics
NPI:1487399705
Name:TOMLIN-HAYNES, CARON LYNN (LMFT)
Entity type:Individual
Prefix:
First Name:CARON
Middle Name:LYNN
Last Name:TOMLIN-HAYNES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:473 EAST CARNEGIE DRIVE SUITE 200
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408
Mailing Address - Country:US
Mailing Address - Phone:213-373-3749
Mailing Address - Fax:
Practice Address - Street 1:473 S CARNEGIE DR STE 200
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-4201
Practice Address - Country:US
Practice Address - Phone:213-373-3749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-02
Last Update Date:2024-10-28
Deactivation Date:2023-02-03
Deactivation Code:
Reactivation Date:2024-10-28
Provider Licenses
StateLicense IDTaxonomies
CA103568106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty