Healthcare Provider Details

I. General information

NPI: 1346312576
Provider Name (Legal Business Name): MS. SHEILA JOYCE HINES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S C ST STE A
LOMPOC CA
93436-7340
US

IV. Provider business mailing address

PO BOX 6090
LOS OSOS CA
93412-6090
US

V. Phone/Fax

Practice location:
  • Phone: 805-735-4376
  • Fax: 805-737-3251
Mailing address:
  • Phone: 805-234-7388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC35812
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: