Provider Demographics
NPI:1215065123
Name:HINES, MITZI LEIGH (LCSW)
Entity type:Individual
Prefix:MS
First Name:MITZI
Middle Name:LEIGH
Last Name:HINES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 MARSDEN AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37216-3923
Mailing Address - Country:US
Mailing Address - Phone:615-424-4615
Mailing Address - Fax:844-308-5069
Practice Address - Street 1:1900 CHURCH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2234
Practice Address - Country:US
Practice Address - Phone:615-596-3030
Practice Address - Fax:844-308-5069
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW43941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3927430Medicaid
TN3927430Medicare PIN