Provider Demographics
NPI:1629517289
Name:HINKSON, DEMETRIC
Entity Type:Individual
Prefix:
First Name:DEMETRIC
Middle Name:
Last Name:HINKSON
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 1:4073 N LAKE ORLANDO PKWY
Mailing Address - Street 2:APT 2302
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-2200
Mailing Address - Country:US
Mailing Address - Phone:407-308-1864
Mailing Address - Fax:
Practice Address - Street 1:4073 N LAKE ORLANDO PKWY
Practice Address - Street 2:APT 2302
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-2200
Practice Address - Country:US
Practice Address - Phone:407-308-1864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician