Provider Demographics
NPI:1518060144
Name:HINES, JO WALKER (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JO
Middle Name:WALKER
Last Name:HINES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:JO
Other - Middle Name:S
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:141 MEADOW VIEW DR.
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730
Mailing Address - Country:US
Mailing Address - Phone:870-863-3235
Mailing Address - Fax:
Practice Address - Street 1:2200 FT. ROOTS DR.
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114
Practice Address - Country:US
Practice Address - Phone:870-881-4477
Practice Address - Fax:870-881-4442
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-10901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
5U291OtherBCBS PROVIDER NUMBER
5U291OtherBCBS PROVIDER NUMBER