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General NPI Number Information
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NPI Number | 1598143612
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Entity Type | Organization
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Legal Business Name | STEPHANIE VINES, NCC, LPC, LLC
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Dates
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Enumeration Date | 05/08/2015
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Last Update Date | 05/08/2015
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Provider Practice Location Address
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Address Line | 152 W. MAIN ST.
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City | NEW IBERIA
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State | LA
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Zip | 70560
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Country | US
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Telephone | 337-380-6803
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 11427
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City | NEW IBERIA
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State | LA
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Zip | 70562
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Country | US
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Telephone | 337-380-6803
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | STEPHANIE LYNN VINES
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Credential | LPC
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Telephone | 337-380-6803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2390
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License Number State | LA
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