Provider Demographics
NPI: | 1376194191 |
---|---|
Name: | HINES, ANNA (MSW, LCSWA) |
Entity Type: | Individual |
Prefix: | |
First Name: | ANNA |
Middle Name: | |
Last Name: | HINES |
Suffix: | |
Gender: | F |
Credentials: | MSW, LCSWA |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 284 EXECUTIVE PARK DR STE 100 |
Mailing Address - Street 2: | |
Mailing Address - City: | CONCORD |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28025-1833 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 704-939-1100 |
Mailing Address - Fax: | 704-939-1173 |
Practice Address - Street 1: | 518 SIGNAL HILL DRIVE EXT |
Practice Address - Street 2: | |
Practice Address - City: | STATESVILLE |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28625-4391 |
Practice Address - Country: | US |
Practice Address - Phone: | 704-871-9605 |
Practice Address - Fax: | 704-873-9917 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2019-09-23 |
Last Update Date: | 2019-11-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | P014075 | 101YA0400X, 101YP2500X, 103T00000X, 106H00000X, 164W00000X, 2084P0804X, 363A00000X, 363LP0808X, 364SP0809X, 1041C0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | |
No | 164W00000X | Nursing Service Providers | Licensed Practical Nurse | |
No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | |
No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health |
No | 364SP0809X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Adult |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NC | YPYW12515848 | Other | BLUE CROSS BLUE SHIELD |