Provider Demographics
NPI:1235550963
Name:HINTON, OCTAVIA SHANICE
Entity Type:Individual
Prefix:
First Name:OCTAVIA
Middle Name:SHANICE
Last Name:HINTON
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 1:2764 OLD HIGHWAY 64 APT 3
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72327-2001
Mailing Address - Country:US
Mailing Address - Phone:870-514-4922
Mailing Address - Fax:
Practice Address - Street 1:2764 OLD HIGHWAY 64 APT 3
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72327-2001
Practice Address - Country:US
Practice Address - Phone:870-514-4922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-24
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW033771041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical