Provider Demographics
NPI:1275771867
Name:HINES, JENEVE (MA LPC)
Entity Type:Individual
Prefix:MRS
First Name:JENEVE
Middle Name:
Last Name:HINES
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15869 SPUR DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-2214
Mailing Address - Country:US
Mailing Address - Phone:586-354-3127
Mailing Address - Fax:
Practice Address - Street 1:15869 SPUR DR
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48042-2214
Practice Address - Country:US
Practice Address - Phone:586-354-3127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013058101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health