| Vine Psychiatric Associates, Llc | |
|
14631 Route 29 Ste 209 Centreville VA 20121-5827 | |
| (703) 830-1800 | |
| (703) 830-1800 |
| Full Name | Vine Psychiatric Associates, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 14631 Route 29 Ste 209, Centreville, Virginia |
| Authorized Official Name and Position | Young Hoon Bae (OWNER) |
| Authorized Official Contact | 7038301800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vine Psychiatric Associates, Llc 14631 Route 29 Ste 209 Centreville VA 20121-5827 Ph: (703) 830-1800 | Vine Psychiatric Associates, Llc 14631 Route 29 Ste 209 Centreville VA 20121-5827 Ph: (703) 830-1800 |
| NPI Number | 1891270435 |
|---|---|
| Provider Enumeration Date | 09/29/2018 |
| Last Update Date | 06/13/2024 |
| Certification Date | 06/13/2024 |
| Medicare PECOS PAC ID | 0648519777 |
|---|---|
| Medicare Enrollment ID | O20190802001458 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891270435 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Young H Bae |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619931680 PECOS PAC ID: 1355317942 Enrollment ID: I20160204001723 |
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