Provider Demographics
NPI:1255405908
Name:VINE PASTORAL COUNSELING CENTER, INC.
Entity type:Organization
Organization Name:VINE PASTORAL COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:W
Authorized Official - Last Name:RAGLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DMIN
Authorized Official - Phone:256-461-8580
Mailing Address - Street 1:333 FRANKLIN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4264
Mailing Address - Country:US
Mailing Address - Phone:256-461-8580
Mailing Address - Fax:256-517-8382
Practice Address - Street 1:333 FRANKLIN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4264
Practice Address - Country:US
Practice Address - Phone:256-461-8580
Practice Address - Fax:256-517-8382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLMFT106H00000X
ALLMFT110106H00000X
ALLMFT126106H00000X
ALLMFT99106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty