Provider Demographics
NPI:1558975888
Name:HINES, ERICK
Entity Type:Individual
Prefix:
First Name:ERICK
Middle Name:
Last Name:HINES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 MANTUA PIKE STE 701-196
Mailing Address - Street 2:
Mailing Address - City:MANTUA
Mailing Address - State:NJ
Mailing Address - Zip Code:08051-1606
Mailing Address - Country:US
Mailing Address - Phone:856-246-7049
Mailing Address - Fax:
Practice Address - Street 1:320 MACDADE BLVD STE 205
Practice Address - Street 2:
Practice Address - City:COLLINGDALE
Practice Address - State:PA
Practice Address - Zip Code:19023-1926
Practice Address - Country:US
Practice Address - Phone:610-522-4506
Practice Address - Fax:610-522-4508
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)