Healthcare Provider Details

I. General information

NPI: 1417869702
Provider Name (Legal Business Name): IMANI CAMILLE HINES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 E BESSEMER AVE
GREENSBORO NC
27401-6324
US

IV. Provider business mailing address

213 E BESSEMER AVE
GREENSBORO NC
27401-6324
US

V. Phone/Fax

Practice location:
  • Phone: 336-379-7144
  • Fax:
Mailing address:
  • Phone: 336-379-7144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP024335
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: