Provider Demographics
NPI:1508134495
Name:HINES, GINA K (LCPC)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:K
Last Name:HINES
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 31ST ST STE 105
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-5535
Mailing Address - Country:US
Mailing Address - Phone:630-206-9123
Mailing Address - Fax:630-598-9123
Practice Address - Street 1:1101 31ST ST STE 105
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-5535
Practice Address - Country:US
Practice Address - Phone:630-587-3777
Practice Address - Fax:630-587-3179
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008017101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional