Provider Demographics
NPI:1912238718
Name:VINING, JOHN K (LPC, MHSP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:K
Last Name:VINING
Suffix:
Gender:M
Credentials:LPC, MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 N OCOEE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-5093
Mailing Address - Country:US
Mailing Address - Phone:423-476-1933
Mailing Address - Fax:423-559-1848
Practice Address - Street 1:555 N OCOEE ST STE 2
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-5093
Practice Address - Country:US
Practice Address - Phone:423-476-1933
Practice Address - Fax:423-559-1848
Is Sole Proprietor?:No
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000000694101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health