Healthcare Provider Details

I. General information

NPI: 1053452144
Provider Name (Legal Business Name): HAROLD S HINES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12625 HESPERIA RD
VICTORVILLE CA
92395-7720
US

IV. Provider business mailing address

PO BOX 3633
VICTORVILLE CA
92393-3633
US

V. Phone/Fax

Practice location:
  • Phone: 760-955-1777
  • Fax:
Mailing address:
  • Phone: 760-955-1777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: