Provider Demographics
NPI:1093288151
Name:VANSTOLK, HEATHER ELIZABETH (MA, EDS)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:ELIZABETH
Last Name:VANSTOLK
Suffix:
Gender:F
Credentials:MA, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:DE
Mailing Address - Zip Code:19804-2700
Mailing Address - Country:US
Mailing Address - Phone:302-992-5535
Mailing Address - Fax:
Practice Address - Street 1:1502 SPRUCE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-2148
Practice Address - Country:US
Practice Address - Phone:302-552-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE90418103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool