Healthcare Provider Details

I. General information

NPI: 1134269210
Provider Name (Legal Business Name): GEORGIA G HYNES CCDP,CCS,CAC,NCACII
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 TITUS RD BOX 560
WASHINGTON DEPOT CT
06794-1517
US

IV. Provider business mailing address

8 TITUS RD P.O. BOX 560
WASHINGTON DEPOT CT
06794-1517
US

V. Phone/Fax

Practice location:
  • Phone: 860-868-0857
  • Fax: 860-868-1288
Mailing address:
  • Phone: 860-868-0857
  • Fax: 860-868-1288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number000322
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number000322
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: