Healthcare Provider Details

I. General information

NPI: 1730552936
Provider Name (Legal Business Name): STACEY HINSON LMHC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2015
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 OMA OPA LN
COTTONDALE FL
32431-7338
US

IV. Provider business mailing address

PO BOX 103
COTTONDALE FL
32431-0103
US

V. Phone/Fax

Practice location:
  • Phone: 850-557-7308
  • Fax:
Mailing address:
  • Phone: 850-557-7308
  • Fax: 850-248-2469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH13734
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4370
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: