Provider Demographics
NPI:1033103650
Name:VANDE KEMP, HENDRIKA (PHD)
Entity Type:Individual
Prefix:DR
First Name:HENDRIKA
Middle Name:
Last Name:VANDE KEMP
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7815 REBEL DR
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-1429
Mailing Address - Country:US
Mailing Address - Phone:703-698-8881
Mailing Address - Fax:
Practice Address - Street 1:7815 REBEL DR
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-1429
Practice Address - Country:US
Practice Address - Phone:703-698-8881
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003170103TC0700X
CA6311103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA709267OtherNATIONAL CAPITAL PPO
VA700715OtherAETNA/MAGELLAN PIN NUMBER
VA515346OtherVALUE OPTIONS/ELC
VA516840OtherVALUEOPTIONS/PCUSA
VIG615 0001OtherCAREFIRST BCBS #
VA278370OtherANTHEM BCBS IDENTIFICATIO
VA491428Medicare ID - Type Unspecified