Provider Demographics
NPI:1801906854
Name:HINES, HOWARD (PHD)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:
Last Name:HINES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9650 SANTIAGO RD
Mailing Address - Street 2:101
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-3957
Mailing Address - Country:US
Mailing Address - Phone:410-995-5587
Mailing Address - Fax:410-992-1779
Practice Address - Street 1:9650 SANTIAGO RD
Practice Address - Street 2:101
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-3957
Practice Address - Country:US
Practice Address - Phone:410-995-5587
Practice Address - Fax:410-992-1779
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02463103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD341L771BMedicare PIN
MDD05950Medicare UPIN