Healthcare Provider Details

I. General information

NPI: 1295471522
Provider Name (Legal Business Name): THE VINE CHRISTIAN COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 PATRIOT PL STE 200
FOXBOROUGH MA
02035-3304
US

IV. Provider business mailing address

26 PATRIOT PL STE 200
FOXBOROUGH MA
02035-3304
US

V. Phone/Fax

Practice location:
  • Phone: 508-838-0885
  • Fax:
Mailing address:
  • Phone: 508-838-0885
  • Fax:

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: MELISSA ANNE HATHAWAY
Title or Position: CEO
Credential: PHD, LMHC
Phone: 508-838-0885