Provider Demographics
NPI:1760777551
Name:HINTON, SHANTINA A (AS BA MA CADC LCAS)
Entity Type:Individual
Prefix:
First Name:SHANTINA
Middle Name:A
Last Name:HINTON
Suffix:
Gender:F
Credentials:AS BA MA CADC LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2774 WAYNE WHITE RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27313-8157
Mailing Address - Country:US
Mailing Address - Phone:336-457-0261
Mailing Address - Fax:336-233-2234
Practice Address - Street 1:201 N. EUGENE ST.
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2221
Practice Address - Country:US
Practice Address - Phone:336-641-6462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NC20248101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor