Provider Demographics
NPI:1578988812
Name:WILLIAMS-HINES, JACQUELINE GAYLE
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:GAYLE
Last Name:WILLIAMS-HINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 HUTCHINSON ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01119-1042
Mailing Address - Country:US
Mailing Address - Phone:413-796-1814
Mailing Address - Fax:
Practice Address - Street 1:34 HUTCHINSON ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01119-1042
Practice Address - Country:US
Practice Address - Phone:413-796-1814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA103K00000XOtherBEHAVIOR ANALYST