Provider Demographics
NPI:1831979343
Name:THE VINE CHRISTIAN MINISTRY
Entity type:Organization
Organization Name:THE VINE CHRISTIAN MINISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:REITENAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MATS, BCPC
Authorized Official - Phone:484-515-8753
Mailing Address - Street 1:1461 GRACE ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6316
Mailing Address - Country:US
Mailing Address - Phone:484-515-8753
Mailing Address - Fax:
Practice Address - Street 1:1414 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-2017
Practice Address - Country:US
Practice Address - Phone:610-866-1388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty