Provider Demographics
NPI:1134273360
Name:VINES, DEBORAH D (LCSW)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:D
Last Name:VINES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 CHURCH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2285
Mailing Address - Country:US
Mailing Address - Phone:727-313-1426
Mailing Address - Fax:615-983-6975
Practice Address - Street 1:2320 W END AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1784
Practice Address - Country:US
Practice Address - Phone:727-313-1426
Practice Address - Fax:615-983-6975
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000040741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN265374000OtherMAGELLAN PROVIDER NUMBER
TN457801OtherVALUE OPTIONS PROVIDER #
TN7239269OtherAETNA PROVIDER NUMBER
TN2072152OtherCIGNA PROVIDER NUMBER
TN4080157OtherBCBS PROVIDER NUMBER
TN7239269OtherAETNA PROVIDER NUMBER