Individual
HEATHER HINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD, LCSW
Contact information
Practice address
7558 KACHINA LOOP, SANTA FE, NM 87507-4042
(518) 428-6881
Mailing address
7558 KACHINA LOOP, SANTA FE, NM 87507-4042
(518) 428-6881
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
1041C0700X
Clinical Social Worker
C-10439
NM
1041C0700X
Clinical Social Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1467037267
—
NM
05
—
35588519
—
NM
Enumeration date
06/20/2016
Last updated
09/11/2024
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