Provider Demographics
NPI:1063644045
Name:HINES, JEANINE L (PLCSW, QP)
Entity Type:Individual
Prefix:MS
First Name:JEANINE
Middle Name:L
Last Name:HINES
Suffix:
Gender:F
Credentials:PLCSW, QP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 N HERRITAGE ST
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-1581
Mailing Address - Country:US
Mailing Address - Phone:252-208-0061
Mailing Address - Fax:252-208-0149
Practice Address - Street 1:2901 N HERRITAGE ST
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-1581
Practice Address - Country:US
Practice Address - Phone:252-208-0061
Practice Address - Fax:252-208-0149
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0051491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical