Provider Demographics
NPI:1679892541
Name:VINES, TARA M (LPC)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:M
Last Name:VINES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:L
Other - Last Name:MCGRAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:333 BUSINESS CIR
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-1778
Mailing Address - Country:US
Mailing Address - Phone:205-510-2780
Mailing Address - Fax:205-510-2790
Practice Address - Street 1:1401 20TH ST S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-4913
Practice Address - Country:US
Practice Address - Phone:205-510-2778
Practice Address - Fax:205-510-2790
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2556101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-082541OtherBLUE CROSS BLUE SHIELD OF AL.