Provider Demographics
NPI:1073830337
Name:HINES, KIMBERLY K (LPCC)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:K
Last Name:HINES
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:DR
Other - First Name:COLLIN
Other - Middle Name:A
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2675 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-2648
Mailing Address - Country:US
Mailing Address - Phone:330-940-2522
Mailing Address - Fax:330-940-3366
Practice Address - Street 1:2675 OAKWOOD DR
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-2648
Practice Address - Country:US
Practice Address - Phone:330-940-2522
Practice Address - Fax:330-940-3366
Is Sole Proprietor?:No
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE 0500477101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE 0500477OtherLICENSE