Provider Demographics
NPI:1134269210
Name:HYNES, GEORGIA G (CCDP,CCS,CAC,NCACII)
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:G
Last Name:HYNES
Suffix:
Gender:F
Credentials:CCDP,CCS,CAC,NCACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 TITUS RD
Mailing Address - Street 2:P.O. BOX 560
Mailing Address - City:WASHINGTON DEPOT
Mailing Address - State:CT
Mailing Address - Zip Code:06794-1517
Mailing Address - Country:US
Mailing Address - Phone:860-868-0857
Mailing Address - Fax:860-868-1288
Practice Address - Street 1:8 TITUS RD
Practice Address - Street 2:BOX 560
Practice Address - City:WASHINGTON DEPOT
Practice Address - State:CT
Practice Address - Zip Code:06794-1517
Practice Address - Country:US
Practice Address - Phone:860-868-0857
Practice Address - Fax:860-868-1288
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000322101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VANCACII -004029OtherNAADAC
CT000322OtherSTATE OF CT DEPARTMENT OF PUBLIC HEALTH
CTCCS-1410OtherCONNECTICUT CERTIFICATION BOARD
NYCAC-4490OtherNEW YORK STATE OASAS
CTCAC-1410OtherCONNECTICUT CERTIFICATION BOARD
CTCCDP-1410OtherCONNECTICUT CERTIFICATION BOARD