Provider Demographics
NPI:1619703600
Name:VINES, BRITTANI (THERAPIST)
Entity type:Individual
Prefix:MISS
First Name:BRITTANI
Middle Name:
Last Name:VINES
Suffix:
Gender:F
Credentials:THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-0021
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:57131 LAKEVIEW RD
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:CA
Practice Address - Zip Code:92309
Practice Address - Country:US
Practice Address - Phone:909-389-8582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)