Healthcare Provider Details

I. General information

NPI: 1639525686
Provider Name (Legal Business Name): JESSE HINTON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2016
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 CORPORATE CENTER CT
STOCKBRIDGE GA
30281-6388
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7630
US

V. Phone/Fax

Practice location:
  • Phone: 770-954-8685
  • Fax:
Mailing address:
  • Phone: 770-954-8685
  • Fax: 845-707-4221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number090018-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number091127-01
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW009392
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: