Provider Demographics
NPI:1184851602
Name:VANKIRK, RANDY K (MA COUNSELING)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:K
Last Name:VANKIRK
Suffix:
Gender:M
Credentials:MA COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 W PIKE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:PA
Mailing Address - Zip Code:15342-1154
Mailing Address - Country:US
Mailing Address - Phone:724-263-0835
Mailing Address - Fax:
Practice Address - Street 1:2121 W PIKE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:PA
Practice Address - Zip Code:15342-1154
Practice Address - Country:US
Practice Address - Phone:724-263-0835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional