Provider Demographics
NPI:1053306084
Name:ALBERS, VICKY L (BA CCDC II)
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:L
Last Name:ALBERS
Suffix:
Gender:F
Credentials:BA CCDC II
Other - Prefix:
Other - First Name:VICKY
Other - Middle Name:L
Other - Last Name:VANDEWEERD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA CCDC II
Mailing Address - Street 1:PO BOX 1030
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-6030
Mailing Address - Country:US
Mailing Address - Phone:605-886-0123
Mailing Address - Fax:605-886-5447
Practice Address - Street 1:123 19TH ST NE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-2823
Practice Address - Country:US
Practice Address - Phone:605-886-0123
Practice Address - Fax:605-886-5447
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD9607912101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)