| The Vine Christian Counseling, Llc | |
|
995 Prince Frederick Blvd Suite 209 Prince Frederick MD 20678-3198 | |
| (410) 610-6602 | |
| Not Available |
| Full Name | The Vine Christian Counseling, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 995 Prince Frederick Blvd, Prince Frederick, Maryland |
| Authorized Official Name and Position | Tamera Ireland Olson (PRESIDENT) |
| Authorized Official Contact | 4106106602 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Vine Christian Counseling, Llc 995 Prince Frederick Blvd Ste 209 Prince Frederick MD 20678-5101 Ph: (410) 610-6602 | The Vine Christian Counseling, Llc 995 Prince Frederick Blvd Suite 209 Prince Frederick MD 20678-3198 Ph: (410) 610-6602 |
| NPI Number | 1790922250 |
|---|---|
| Provider Enumeration Date | 01/20/2009 |
| Last Update Date | 01/03/2011 |
| Medicare PECOS PAC ID | 2365506987 |
|---|---|
| Medicare Enrollment ID | O20090127000309 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790922250 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 14382 (Maryland) | Primary |
| Provider Name | Tamera I Olson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053564898 PECOS PAC ID: 2769546381 Enrollment ID: I20090127000288 |
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