Provider Demographics
NPI:1811449770
Name:HINES, STACI (LLMSW)
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:
Last Name:HINES
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 S SAGINAW ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48502-1817
Mailing Address - Country:US
Mailing Address - Phone:810-953-2427
Mailing Address - Fax:
Practice Address - Street 1:1295 NW 40TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-5801
Practice Address - Country:US
Practice Address - Phone:954-583-4710
Practice Address - Fax:954-967-8141
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010978171041C0700X
FLSW197231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1514Medicaid
FL113970600Medicaid