Provider Demographics
NPI:1770252926
Name:HINES, LAKEISHA EBONIE (LGPC)
Entity type:Individual
Prefix:
First Name:LAKEISHA
Middle Name:EBONIE
Last Name:HINES
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 ALICE AVE APT 103
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3580
Mailing Address - Country:US
Mailing Address - Phone:202-373-8360
Mailing Address - Fax:
Practice Address - Street 1:2000 ALICE AVE APT 103
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3580
Practice Address - Country:US
Practice Address - Phone:202-373-8360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP11885101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor