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General NPI Number Information
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NPI Number | 1902773690
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Entity Type | Organization
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Legal Business Name | FIG & VINE
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Dates
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Enumeration Date | 10/20/2025
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 304 N SUNNY SLOPE ST
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City | WEST FRANKFORT
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State | IL
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Zip | 62896-1650
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Country | US
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Telephone | 618-923-5576
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Fax | 618-923-5576
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Provider Business Mailing Address
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Address Line | 11599 S COUNTY LINE RD
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City | WEST FRANKFORT
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State | IL
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Zip | 62896-4954
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Country | US
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Telephone | 618-923-5576
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. DR TARA CARLOTTA CHAMBERS
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Credential | PHD, LCPC
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Telephone | 618-923-5576
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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