Provider Demographics
NPI:1497571442
Name:HINES, JOHN LINWOOD II (CSAC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:LINWOOD
Last Name:HINES
Suffix:II
Gender:M
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3017 EDINBURGH DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7003
Mailing Address - Country:US
Mailing Address - Phone:757-667-1186
Mailing Address - Fax:
Practice Address - Street 1:409 BIRDNECK CIR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-5516
Practice Address - Country:US
Practice Address - Phone:757-385-6932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704016778101YP2500X
VA0710103732101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional