Provider Demographics
NPI:1093910861
Name:HINES, JOHN CAMPBELL (LPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CAMPBELL
Last Name:HINES
Suffix:
Gender:M
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 HICKORY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-6780
Mailing Address - Country:US
Mailing Address - Phone:336-788-3806
Mailing Address - Fax:
Practice Address - Street 1:1570 NC 8 & 89 HWY N
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:NC
Practice Address - Zip Code:27016
Practice Address - Country:US
Practice Address - Phone:336-593-5286
Practice Address - Fax:336-539-5361
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4427101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health