Healthcare Provider Details

I. General information

NPI: 1174086532
Provider Name (Legal Business Name): VINE CHRISTIAN COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 NW 18TH ST STE 104K
ANKENY IA
50023-9243
US

IV. Provider business mailing address

3311 NW ABILENE RD
ANKENY IA
50023-1279
US

V. Phone/Fax

Practice location:
  • Phone: 515-402-0520
  • Fax: 515-606-3523
Mailing address:
  • Phone: 515-402-0520
  • Fax: 515-605-3523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. MONIQUE JEANETTE MALDONADO
Title or Position: OWNER
Credential: LMHC
Phone: 515-729-8967