Provider Demographics
NPI:1174494066
Name:TRUE VINE COMMUNITY COUNSELING SERVICES
Entity type:Organization
Organization Name:TRUE VINE COMMUNITY COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LCAS-A
Authorized Official - Phone:252-367-9081
Mailing Address - Street 1:1512 N GREENE ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-1221
Mailing Address - Country:US
Mailing Address - Phone:252-367-9081
Mailing Address - Fax:
Practice Address - Street 1:1512 N GREENE ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-1221
Practice Address - Country:US
Practice Address - Phone:252-367-9081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty