Provider Demographics
NPI:1417514381
Name:HINES, TINA LESHELL (LCSW-C)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:LESHELL
Last Name:HINES
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MS
Other - First Name:TINA
Other - Middle Name:LESHELLE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:5527 WHITWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-3749
Mailing Address - Country:US
Mailing Address - Phone:443-610-9287
Mailing Address - Fax:410-488-5424
Practice Address - Street 1:5527 WHITWOOD ROAD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-3749
Practice Address - Country:US
Practice Address - Phone:443-610-9287
Practice Address - Fax:410-488-5424
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-25
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00123541041C0700X
MD187381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD175721100Medicaid