Healthcare Provider Details

I. General information

NPI: 1053275289
Provider Name (Legal Business Name): VINE WITHIN COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1770 S RANDALL RD STE A246
GENEVA IL
60134-4646
US

IV. Provider business mailing address

1770 S RANDALL RD STE A246
GENEVA IL
60134-4646
US

V. Phone/Fax

Practice location:
  • Phone: 630-788-2099
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ALLISON GUIMARAY
Title or Position: MANAGER/OWNER
Credential:
Phone: 630-788-2099