Provider Demographics
NPI:1548040017
Name:VINES, WENDY HODGES (CPSS)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:HODGES
Last Name:VINES
Suffix:
Gender:F
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 W WILLIE MORRIS PKWY
Mailing Address - Street 2:
Mailing Address - City:YAZOO CITY
Mailing Address - State:MS
Mailing Address - Zip Code:39194-7702
Mailing Address - Country:US
Mailing Address - Phone:601-442-4001
Mailing Address - Fax:601-442-3451
Practice Address - Street 1:150 JEFFERSON DAVIS BLVD
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-5107
Practice Address - Country:US
Practice Address - Phone:601-492-4001
Practice Address - Fax:604-442-3451
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health