Organization
VINE LIFE COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALPHONSO IVY JR. LPC (OWNER COUNSELOR)
(314) 420-4733
Entity
Organization
Contact information
Practice address
2310 S GRAND BLVD, SAINT LOUIS, MO 63104-1702
(314) 420-4733
Mailing address
2310 S GRAND BLVD, SAINT LOUIS, MO 63104-1702
(314) 420-4733
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
02/14/2019
Last updated
02/14/2019
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