Provider Demographics
NPI:1669901013
Name:HINE, JULIANA J (MED, LPCC)
Entity type:Individual
Prefix:MRS
First Name:JULIANA
Middle Name:J
Last Name:HINE
Suffix:
Gender:F
Credentials:MED, LPCC
Other - Prefix:MS
Other - First Name:JULIANA
Other - Middle Name:J
Other - Last Name:WHITESELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, LPCC
Mailing Address - Street 1:1609 VERMONT ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-6035
Mailing Address - Country:US
Mailing Address - Phone:505-506-8244
Mailing Address - Fax:
Practice Address - Street 1:1609 VERMONT ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-6035
Practice Address - Country:US
Practice Address - Phone:505-506-8244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH0212621101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1669901013Medicaid