Provider Demographics
NPI:1326211392
Name:VINES, LINDA NICOLE (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:NICOLE
Last Name:VINES
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10967 CHASE PARK LN
Mailing Address - Street 2:APT. E
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-5772
Mailing Address - Country:US
Mailing Address - Phone:314-605-1900
Mailing Address - Fax:
Practice Address - Street 1:10967 CHASE PARK LN
Practice Address - Street 2:APT. E
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-5772
Practice Address - Country:US
Practice Address - Phone:314-605-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060246941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical