Provider Demographics
NPI:1922251115
Name:HINES, JAMES H (LMSW)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:H
Last Name:HINES
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-0010
Mailing Address - Country:US
Mailing Address - Phone:517-676-9788
Mailing Address - Fax:517-676-3438
Practice Address - Street 1:2422 JOLLY RD
Practice Address - Street 2:300
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3686
Practice Address - Country:US
Practice Address - Phone:517-347-6944
Practice Address - Fax:517-347-6912
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010162701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI2833Medicare PIN