Healthcare Provider Details

I. General information

NPI: 1154591550
Provider Name (Legal Business Name): DENISE RENEE HINES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 W BETHEL RD STE 100
COPPELL TX
75019-4474
US

IV. Provider business mailing address

625 BRIARWOOD DR
SOUTHLAKE TX
76092-5405
US

V. Phone/Fax

Practice location:
  • Phone: 972-393-1596
  • Fax: 972-304-0400
Mailing address:
  • Phone: 817-681-5768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number32703
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: