Provider Demographics
NPI:1902063969
Name:HINES, DARYLE C (LPC)
Entity Type:Individual
Prefix:MRS
First Name:DARYLE
Middle Name:C
Last Name:HINES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 BRIGHTON PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-6304
Mailing Address - Country:US
Mailing Address - Phone:704-535-2224
Mailing Address - Fax:704-536-6708
Practice Address - Street 1:6050 HICKORY GROVE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-4130
Practice Address - Country:US
Practice Address - Phone:704-531-4068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC818101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional