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General NPI Number Information
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NPI Number | 1154348027
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Entity Type | Individual
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Provider Name | MIA D HINES LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 05/18/2016
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Provider Practice Location Address
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Address Line | 2707 BROWNS LN
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City | JONESBORO
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State | AR
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Zip | 72401-7213
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Country | US
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Telephone | 890-972-4939
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Fax | 870-972-4911
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Provider Business Mailing Address
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Address Line | 3808 KISKADEE CT
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City | INDIANAPOLIS
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State | IN
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Zip | 46228-1514
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Country | US
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Telephone | 317-402-5572
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2028-C
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34004822A
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License Number State | IN
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