Provider Demographics
NPI:1699718155
Name:HINES, LARRY G (CSAC, CCS)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:G
Last Name:HINES
Suffix:
Gender:M
Credentials:CSAC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 MERRIMON AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-3456
Mailing Address - Country:US
Mailing Address - Phone:828-255-2045
Mailing Address - Fax:828-255-2041
Practice Address - Street 1:640 MERRIMON AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-3400
Practice Address - Country:US
Practice Address - Phone:828-255-2045
Practice Address - Fax:828-255-2041
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC894101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)