Provider Demographics
NPI:1316049117
Name:VINES, GLORIA S (LCSW-C)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:S
Last Name:VINES
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64277
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4277
Mailing Address - Country:US
Mailing Address - Phone:410-328-7037
Mailing Address - Fax:410-328-3311
Practice Address - Street 1:701 W PRATT ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1023
Practice Address - Country:US
Practice Address - Phone:410-328-1406
Practice Address - Fax:410-328-1614
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD858YMedicare ID - Type Unspecified