Provider Demographics
NPI:1174340939
Name:HINES, DAISY MARIE (LCMHCA)
Entity type:Individual
Prefix:MRS
First Name:DAISY
Middle Name:MARIE
Last Name:HINES
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2229 EVER CHASE CT
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6324
Mailing Address - Country:US
Mailing Address - Phone:804-218-1147
Mailing Address - Fax:
Practice Address - Street 1:2229 EVER CHASE CT
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6324
Practice Address - Country:US
Practice Address - Phone:804-218-1147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20477101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health