Healthcare Provider Details

I. General information

NPI: 1265096408
Provider Name (Legal Business Name): TIFFANY MONIQUE HINES LMHC, CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 DECATUR AVENUE APT LJ
NEW YORK NY
10467
US

IV. Provider business mailing address

3540 DECATUR AVENUE APT LJ
NEW YORK NY
10467
US

V. Phone/Fax

Practice location:
  • Phone: 917-891-9427
  • Fax:
Mailing address:
  • Phone: 917-891-9427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number015224
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: