Provider Demographics
NPI:1316583214
Name:CHURCH-HINES, KENI SANITA (LCMHC)
Entity type:Individual
Prefix:
First Name:KENI
Middle Name:SANITA
Last Name:CHURCH-HINES
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 SOUTHERLAND ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-2315
Mailing Address - Country:US
Mailing Address - Phone:984-222-9272
Mailing Address - Fax:
Practice Address - Street 1:131 SOUTHERLAND ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-2315
Practice Address - Country:US
Practice Address - Phone:984-222-9272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15368101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health