Healthcare Provider Details

I. General information

NPI: 1649744848
Provider Name (Legal Business Name): DELONDRIA HINES LCMHCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 S MIAMI BLVD STE 136
DURHAM NC
27703-5799
US

IV. Provider business mailing address

2310 S MIAMI BLVD STE 136
DURHAM NC
27703-5799
US

V. Phone/Fax

Practice location:
  • Phone: 919-756-6116
  • Fax: 919-200-6860
Mailing address:
  • Phone: 919-756-6116
  • Fax: 919-200-6860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberS14562
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11213
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701012181
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberS14562
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: