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General NPI Number Information
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NPI Number | 1225981350
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Entity Type | Organization
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Legal Business Name | VINES PSYCHIATRY AND COUNSELING LLC
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Dates
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Enumeration Date | 02/18/2026
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Last Update Date | 02/18/2026
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Provider Practice Location Address
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Address Line | 109 JOHN MADDOX DR NW STE 221
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City | ROME
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State | GA
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Zip | 30165-1452
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Country | US
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Telephone | 706-420-3309
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Fax | 706-203-3201
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Provider Business Mailing Address
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Address Line | 109 JOHN MADDOX DR NW STE 221
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City | ROME
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State | GA
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Zip | 30165-1452
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Country | US
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Telephone | 706-420-3309
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Fax | 706-203-3201
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Authorized Official
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Title or Position | CREDENTIALING/BILLING ADMIN
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Name | MICHELLE BONE
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Credential |
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Telephone | 706-409-3072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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