Provider Demographics
NPI:1891270435
Name:VINE PSYCHIATRIC ASSOCIATES,LLC
Entity Type:Organization
Organization Name:VINE PSYCHIATRIC ASSOCIATES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:HOON
Authorized Official - Last Name:BAE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-830-1800
Mailing Address - Street 1:14631 LEE HWY STE 214
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-5827
Mailing Address - Country:US
Mailing Address - Phone:703-830-1800
Mailing Address - Fax:703-830-1801
Practice Address - Street 1:14631 LEE HWY STE 312
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-5834
Practice Address - Country:US
Practice Address - Phone:757-544-8342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-29
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty