Provider Demographics
NPI:1225268956
Name:HINES-DUNN, PAMELA (LISW-S, LCDCIII)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:HINES-DUNN
Suffix:
Gender:F
Credentials:LISW-S, LCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1283 CONANT ST
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1607
Mailing Address - Country:US
Mailing Address - Phone:419-482-6032
Mailing Address - Fax:419-482-6740
Practice Address - Street 1:1283 CONANT ST
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1607
Practice Address - Country:US
Practice Address - Phone:419-482-6032
Practice Address - Fax:419-482-6740
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH991801101YA0400X
OHI9871-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)