Organization
THE VINE & THE BRANCHES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELLA MARIA LEWIS LCPC (OWNER)
(309) 635-5655
Entity
Organization
Contact information
Practice address
112 S MAIN ST, WASHINGTON, IL 61571-2552
(309) 635-5655
Mailing address
112 S MAIN ST, WASHINGTON, IL 61571-2552
(309) 635-5655
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
07/06/2023
Last updated
07/06/2023
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