Provider Demographics
NPI:1679614986
Name:HINES, LINDA JEAN (LCSW)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:JEAN
Last Name:HINES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:L.
Other - Middle Name:JEAN
Other - Last Name:HINES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:10918 S SPRINGBORO RD
Mailing Address - Street 2:
Mailing Address - City:BROOKSTON
Mailing Address - State:IN
Mailing Address - Zip Code:47923-8277
Mailing Address - Country:US
Mailing Address - Phone:765-427-8019
Mailing Address - Fax:
Practice Address - Street 1:839 MAIN ST STE 551
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47901-2830
Practice Address - Country:US
Practice Address - Phone:765-427-8019
Practice Address - Fax:765-347-2752
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005778A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN12024387OtherCAQH
INM300048347OtherMEDICARE UPIN
IN12024387OtherCAQH