Provider Demographics
NPI:1043935687
Name:VANDENBOOM, DEBRA L (MAPCC LLPC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:VANDENBOOM
Suffix:
Gender:F
Credentials:MAPCC LLPC
Other - Prefix:
Other - First Name:DEBI
Other - Middle Name:
Other - Last Name:VANDENBOOM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2900 CLEVELAND AVE APT 212
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-2364
Mailing Address - Country:US
Mailing Address - Phone:262-325-7424
Mailing Address - Fax:
Practice Address - Street 1:1850 COLFAX AVE
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-6753
Practice Address - Country:US
Practice Address - Phone:269-926-6199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451020862101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health