Provider Demographics
NPI:1720336902
Name:VINES, RACHEL P (MA, LPC-S; RPT-S)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:P
Last Name:VINES
Suffix:
Gender:F
Credentials:MA, LPC-S; RPT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 SUN MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-7291
Mailing Address - Country:US
Mailing Address - Phone:979-595-5129
Mailing Address - Fax:
Practice Address - Street 1:3141 BRIARCREST DR
Practice Address - Street 2:SUITE 510
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3057
Practice Address - Country:US
Practice Address - Phone:979-774-2863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-20
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65196101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional