The Vine Christian Counseling, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

14382 Issued in MD

Legal business name

THE VINE CHRISTIAN COUNSELING, LLC

Practice address

995 Prince Frederick Blvd
Suite 209
Prince Frederick, MD 20678-3198

Phone

(410) 610-6602

NPI assigned

Jan 20, 2009

Last updated

Jan 3, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Tamera Ireland Olson, LCSW-CNPI 1053564898

Title

President

Phone

(410) 610-6602

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tamera Ireland Olson, LCSW-C

  • Clinical Social Worker
  • Prince Frederick, MD
  • NPI 1053564898
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1232409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294012800000",
    "number": "1790922250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "995 PRINCE FREDERICK BLVD STE 209",
            "city": "PRINCE FREDERICK",
            "state": "MD",
            "postal_code": "206785101",
            "telephone_number": "410-610-6602",
            "fax_number": "410-535-2226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "995 PRINCE FREDERICK BLVD",
            "address_2": "SUITE 209",
            "city": "PRINCE FREDERICK",
            "state": "MD",
            "postal_code": "206783198",
            "telephone_number": "410-610-6602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE VINE CHRISTIAN COUNSELING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-20",
        "last_updated": "2011-01-03",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "TAMERA",
        "authorized_official_middle_name": "IRELAND",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "410-610-6602",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW-C"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "14382",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Prince Frederick, MD
• Providers in Prince Frederick, MD by specialty
• Clinical Social Worker in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.