Provider Demographics
NPI:1528192796
Name:HINES, LAURIE ANN (CSAC)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:ANN
Last Name:HINES
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 LAKE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-6785
Mailing Address - Country:US
Mailing Address - Phone:715-848-4600
Mailing Address - Fax:715-845-5398
Practice Address - Street 1:1100 LAKE VIEW DR
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-6785
Practice Address - Country:US
Practice Address - Phone:715-484-4600
Practice Address - Fax:715-845-5398
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1632-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)