Provider Demographics
NPI:1124595533
Name:HINES, VANIQUA
Entity Type:Individual
Prefix:
First Name:VANIQUA
Middle Name:
Last Name:HINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 W WENDOVER AVE STE A
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-1525
Mailing Address - Country:US
Mailing Address - Phone:336-294-1349
Mailing Address - Fax:
Practice Address - Street 1:3405 W WENDOVER AVE STE A
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1525
Practice Address - Country:US
Practice Address - Phone:336-294-1349
Practice Address - Fax:336-292-6711
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2019-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP013004104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker