Provider Demographics
NPI:1326425372
Name:HINES, JOSEPH EMANUEL (LMSW)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:EMANUEL
Last Name:HINES
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 S MAIN ST STE 103C
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-7900
Mailing Address - Country:US
Mailing Address - Phone:248-579-9791
Mailing Address - Fax:
Practice Address - Street 1:148 S MAIN ST STE 103C
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-7900
Practice Address - Country:US
Practice Address - Phone:248-579-9791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010876401041C0700X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool