Provider Demographics
NPI:1841484490
Name:VINER COUNSELING CENTER
Entity type:Organization
Organization Name:VINER COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:VINER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:662-226-3762
Mailing Address - Street 1:PO BOX 1251
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38902-1251
Mailing Address - Country:US
Mailing Address - Phone:662-226-3762
Mailing Address - Fax:
Practice Address - Street 1:501 SOUTHWEST FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901
Practice Address - Country:US
Practice Address - Phone:662-226-3762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0563251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health