Healthcare Provider Details

I. General information

NPI: 1427986231
Provider Name (Legal Business Name): JADE IMARI HINES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 GATEWAY CIR
SAINT JOHNS FL
32259-4084
US

IV. Provider business mailing address

PO BOX 88
HAMPTON FL
32044-0088
US

V. Phone/Fax

Practice location:
  • Phone: 904-893-3237
  • Fax:
Mailing address:
  • Phone: 904-893-3237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: