Provider Demographics
NPI:1396076667
Name:HINES, PORTIA T (MS)
Entity type:Individual
Prefix:
First Name:PORTIA
Middle Name:T
Last Name:HINES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 JEFFERSON ST N
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4813
Mailing Address - Country:US
Mailing Address - Phone:256-970-9133
Mailing Address - Fax:256-513-4172
Practice Address - Street 1:107 JEFFERSON ST N
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4813
Practice Address - Country:US
Practice Address - Phone:256-970-9133
Practice Address - Fax:256-513-4172
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor