Provider Demographics
NPI:1740175884
Name:HINE, KEARA ALENE
Entity type:Individual
Prefix:
First Name:KEARA
Middle Name:ALENE
Last Name:HINE
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 1:2014 S NEWMARK AVE
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-8702
Mailing Address - Country:US
Mailing Address - Phone:209-601-1337
Mailing Address - Fax:
Practice Address - Street 1:2014 S NEWMARK AVE
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:CA
Practice Address - Zip Code:93657-8702
Practice Address - Country:US
Practice Address - Phone:209-601-1337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY9493654103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst