Healthcare Provider Details

I. General information

NPI: 1235063645
Provider Name (Legal Business Name): KRISTAL HINES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15021 LOST CANYON CT APT 103
WOODBRIDGE VA
22191-4907
US

IV. Provider business mailing address

2525 POINTE CENTER CT
DUMFRIES VA
22026-2275
US

V. Phone/Fax

Practice location:
  • Phone: 571-406-5641
  • Fax:
Mailing address:
  • Phone: 571-406-5641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: