Provider Demographics
NPI:1740091594
Name:WINES, KATELIN VICTORIA
Entity type:Individual
Prefix:
First Name:KATELIN
Middle Name:VICTORIA
Last Name:WINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-2653
Mailing Address - Country:US
Mailing Address - Phone:434-386-8983
Mailing Address - Fax:
Practice Address - Street 1:2001 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-2653
Practice Address - Country:US
Practice Address - Phone:434-386-8983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician