Provider Demographics
NPI:1871804161
Name:LEMINE, VICKI DIANNE (LICSW)
Entity type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:DIANNE
Last Name:LEMINE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 VENTURE DR
Mailing Address - Street 2:#218
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-7306
Mailing Address - Country:US
Mailing Address - Phone:304-276-8261
Mailing Address - Fax:
Practice Address - Street 1:1063 MAPLE DR
Practice Address - Street 2:SUITE 4 B
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2848
Practice Address - Country:US
Practice Address - Phone:304-276-8261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP004522611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical