Provider Demographics
NPI:1316570971
Name:THE VINE WELLNESS GROUP, LLC
Entity Type:Organization
Organization Name:THE VINE WELLNESS GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:
Authorized Official - Last Name:INMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:210-602-2203
Mailing Address - Street 1:14802 JONES MALTSBERGER RD STE 1101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-3571
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:210-519-2758
Practice Address - Street 1:14802 JONES MALTSBERGER RD STE 1101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-3571
Practice Address - Country:US
Practice Address - Phone:210-490-4419
Practice Address - Fax:210-519-2758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty