# VINE COUNSELING PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780560771
- **Authorized official:** STACI LYN JACKSON LMFT (CEO)
- **Authorized official phone:** (607) 207-6681

## Contact information

- **Practice address:** 1136 MAIN ST, LEICESTER, MA 01524-1349
- **Practice address phone:** (607) 207-6681
- **Mailing address:** 436 SOUTHBRIDGE ST, SUITE 2 \#1006, AUBURN, MA 01501
- **Mailing address phone:** (607) 207-6681
- **Mailing address fax:** (607) 207-6681

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |

## Other

- **Enumeration date:** 08/14/2025
- **Last updated:** 08/14/2025