Healthcare Provider Details

I. General information

NPI: 1831979343
Provider Name (Legal Business Name): THE VINE CHRISTIAN MINISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 PENNSYLVANIA AVE
BETHLEHEM PA
18018-2017
US

IV. Provider business mailing address

1461 GRACE ST
ALLENTOWN PA
18103-6316
US

V. Phone/Fax

Practice location:
  • Phone: 610-866-1388
  • Fax:
Mailing address:
  • Phone: 484-515-8753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDREW LEE REITENAUER
Title or Position: PRESIDENT/COUNSELOR
Credential: MA, MATS, BCPC
Phone: 484-515-8753