Healthcare Provider Details

I. General information

NPI: 1831541515
Provider Name (Legal Business Name): CHARENA HINES LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29200 NORTHWESTERN HWY STE 110
SOUTHFIELD MI
48034-1055
US

IV. Provider business mailing address

29200 NORTHWESTERN HWY STE 110
SOUTHFIELD MI
48034-1055
US

V. Phone/Fax

Practice location:
  • Phone: 248-276-8000
  • Fax:
Mailing address:
  • Phone: 248-276-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6451025316
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: