Healthcare Provider Details

I. General information

NPI: 1811449770
Provider Name (Legal Business Name): STACI HINES LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 N POWERLINE RD
POMPANO BEACH FL
33069-5713
US

IV. Provider business mailing address

5010 HOLLYWOOD BLVD # 5012
HOLLYWOOD FL
33021-6557
US

V. Phone/Fax

Practice location:
  • Phone: 954-970-8805
  • Fax:
Mailing address:
  • Phone: 954-266-2999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801097817
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW19723
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: