Provider Demographics
NPI:1033432794
Name:HINES, MARIE ELIZABETH (MS CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:ELIZABETH
Last Name:HINES
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8757 ANTONIA AVE
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-6101
Mailing Address - Country:US
Mailing Address - Phone:703-331-1350
Mailing Address - Fax:
Practice Address - Street 1:8757 ANTONIA AVE
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-6101
Practice Address - Country:US
Practice Address - Phone:703-331-1350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202002518235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist