MEDICARE: OLIVIA HINES LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0701006678	VA

General Provider Information

NPI Number	:	1740735661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA HINES LPC

Provider Business Mailing Address
First Line	:	7635 HULL STREET RD
Second Line	:	201
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-6436
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7635 HULL STREET RD
Second Line	:	201
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-6436
Country	:	US
Telephone Number	:	804-447-6382
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2016
Last Update Date	:	10/04/2016

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Directions to “ OLIVIA HINES LPC” Practice Location

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