Provider Demographics
NPI:1891962841
Name:VINES, PATRICIA HAWKINS (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:HAWKINS
Last Name:VINES
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5411 HARVEST MOON LN
Mailing Address - Street 2:COLUMBIA
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-1806
Mailing Address - Country:US
Mailing Address - Phone:410-730-9064
Mailing Address - Fax:410-730-9064
Practice Address - Street 1:5411 HARVEST MOON LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-1806
Practice Address - Country:US
Practice Address - Phone:410-730-9064
Practice Address - Fax:410-730-9064
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD:LCO435101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD52 2224354OtherMD STATE TAXPAYER IDENTIFICATION NUMBER