Provider Demographics
NPI:1417407081
Name:VINING, MICHELE L (MA, PLPC)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:L
Last Name:VINING
Suffix:
Gender:F
Credentials:MA, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7418 FOLEY DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-2301
Mailing Address - Country:US
Mailing Address - Phone:618-972-8881
Mailing Address - Fax:
Practice Address - Street 1:5016 N ILLINOIS ST
Practice Address - Street 2:SUITE A
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-3411
Practice Address - Country:US
Practice Address - Phone:618-398-7250
Practice Address - Fax:618-234-6311
Is Sole Proprietor?:No
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008948101YP2500X
MO2016018719101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional