Provider Demographics
NPI:1164604609
Name:JENNIFER R. VINES LCSW INC
Entity Type:Organization
Organization Name:JENNIFER R. VINES LCSW INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ROGERS
Authorized Official - Last Name:VINES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:337-235-5088
Mailing Address - Street 1:601 W SAINT MARY BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-3568
Mailing Address - Country:US
Mailing Address - Phone:337-235-5088
Mailing Address - Fax:337-261-1152
Practice Address - Street 1:601 W SAINT MARY BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-3568
Practice Address - Country:US
Practice Address - Phone:337-235-5088
Practice Address - Fax:337-261-1152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA30641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty