Provider Demographics
NPI:1306297213
Name:TINA WINEMILLER THERAPY LLC
Entity type:Organization
Organization Name:TINA WINEMILLER THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MENTAL HEALTH THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WINEMILLLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC MRC
Authorized Official - Phone:919-636-0762
Mailing Address - Street 1:1230 SE MAYNARD RD STE 201
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-6945
Mailing Address - Country:US
Mailing Address - Phone:919-636-0762
Mailing Address - Fax:513-826-9314
Practice Address - Street 1:1230 SE MAYNARD RD STE 201
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6945
Practice Address - Country:US
Practice Address - Phone:919-636-0762
Practice Address - Fax:513-826-9314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11331101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1205133386OtherINDIVIDUAL NPI