Healthcare Provider Details

I. General information

NPI: 1306230081
Provider Name (Legal Business Name): AMANDA CRYSTAL HINES LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA ANDERSON

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 ERDMAN AVE
BALTIMORE MD
21213-1720
US

IV. Provider business mailing address

4006 WALNUT AVE
BALTIMORE MD
21206-1522
US

V. Phone/Fax

Practice location:
  • Phone: 410-558-4800
  • Fax: 410-675-8947
Mailing address:
  • Phone: 410-501-9591
  • Fax: 443-224-3142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17980
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: