Healthcare Provider Details

I. General information

NPI: 1972574630
Provider Name (Legal Business Name): ROBERT JOSEPH HINES PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 JOHN PAUL JONES CIR
PORTSMOUTH VA
23708-2111
US

IV. Provider business mailing address

1281 KASBA CT
VIRGINIA BEACH VA
23464-8860
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-7641
  • Fax:
Mailing address:
  • Phone: 757-495-6805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1204
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: