1790922250 NPI number — THE VINE CHRISTIAN COUNSELING, LLC

Table of content: (NPI 1790922250)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790922250 NPI number — THE VINE CHRISTIAN COUNSELING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE VINE CHRISTIAN COUNSELING, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790922250
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
995 PRINCE FREDERICK BLVD STE 209
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRINCE FREDERICK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20678-5101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-610-6602
Provider Business Mailing Address Fax Number:
410-535-2226

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
995 PRINCE FREDERICK BLVD
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
PRINCE FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20678-3198
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-610-6602
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
OLSON
Authorized Official First Name:
TAMERA
Authorized Official Middle Name:
IRELAND
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-610-6602

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  14382 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com