Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 1468 | NC |
Y | 103T00000X | Psychologist | 1468 | NC |
NPI | 1003972050 |
---|---|
Provider Name | Dr. Larry Lonel Hines |
First Address | Winterville, NC 28590-9562 |
Second Address | Greenville, NC 27834-2868 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 11/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03196 | BCBS ID NUMBER (01) | NC |
1468 | NC LICENSE NUMBER (01) | NC |
6000392 | (05) | NC |