Provider Demographics
NPI:1174212195
Name:HINES, CARVIN MICHAEL
Entity type:Individual
Prefix:
First Name:CARVIN
Middle Name:MICHAEL
Last Name:HINES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3206 CURTIS DR APT 112
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-1238
Mailing Address - Country:US
Mailing Address - Phone:202-517-5864
Mailing Address - Fax:
Practice Address - Street 1:1050 NEW JERSEY AVE NW APT 614
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-1346
Practice Address - Country:US
Practice Address - Phone:202-525-5119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion