Provider Demographics
NPI:1972331569
Name:VINE COUNSELING & ASSOCIATES, PLLC
Entity type:Organization
Organization Name:VINE COUNSELING & ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARNEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:984-401-9354
Mailing Address - Street 1:300 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-4200
Mailing Address - Country:US
Mailing Address - Phone:984-401-9354
Mailing Address - Fax:
Practice Address - Street 1:300 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-4200
Practice Address - Country:US
Practice Address - Phone:984-401-9354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty