Provider Demographics
NPI:1477227122
Name:VINES, MELISA (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:MELISA
Middle Name:
Last Name:VINES
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3644A RAINBOW DR
Mailing Address - Street 2:
Mailing Address - City:RAINBOW CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35906-6313
Mailing Address - Country:US
Mailing Address - Phone:256-613-2678
Mailing Address - Fax:
Practice Address - Street 1:3644A RAINBOW DR
Practice Address - Street 2:
Practice Address - City:RAINBOW CITY
Practice Address - State:AL
Practice Address - Zip Code:35906-6313
Practice Address - Country:US
Practice Address - Phone:256-613-2678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL4376101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor