Provider Demographics
NPI:1447496773
Name:HINES, DENA (MED, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:DENA
Middle Name:
Last Name:HINES
Suffix:
Gender:
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 GEORGIA DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-7718
Mailing Address - Country:US
Mailing Address - Phone:252-373-3270
Mailing Address - Fax:
Practice Address - Street 1:3905 GEORGIA DR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-7718
Practice Address - Country:US
Practice Address - Phone:252-373-3270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-16
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4539235Z00000X
CA29336235Z00000X
NC9242235Z00000X
GASLP007874235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist