Healthcare Provider Details

I. General information

NPI: 1760777551
Provider Name (Legal Business Name): SHANTINA A. HINTON AS BA MA CADC LCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 S COX ST STE B2
ASHEBORO NC
27203-6493
US

IV. Provider business mailing address

2774 WAYNE WHITE RD
PLEASANT GARDEN NC
27313-8157
US

V. Phone/Fax

Practice location:
  • Phone: 336-628-0047
  • Fax: 336-233-2234
Mailing address:
  • Phone: 336-457-0261
  • Fax: 336-233-2234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number20248
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: