Provider Demographics
NPI:1073155081
Name:HINES, VICKI LYNNE (CADCII)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:LYNNE
Last Name:HINES
Suffix:
Gender:F
Credentials:CADCII
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:LYNNE
Other - Last Name:HINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADCII
Mailing Address - Street 1:1237 B ST
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-2239
Mailing Address - Country:US
Mailing Address - Phone:619-410-4812
Mailing Address - Fax:
Practice Address - Street 1:1237 B ST
Practice Address - Street 2:
Practice Address - City:WASHOUGAL
Practice Address - State:WA
Practice Address - Zip Code:98671-2239
Practice Address - Country:US
Practice Address - Phone:619-410-4812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAII060320818101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAII060320818OtherCALIFORNIA CONSORTIUM OF ADDICTION PROFESSIONALS