Provider Demographics
NPI:1205227402
Name:VANWYCK, ANNA DEETTE (LPC)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:DEETTE
Last Name:VANWYCK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 TAYLOR AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2200
Mailing Address - Country:US
Mailing Address - Phone:231-329-4262
Mailing Address - Fax:888-972-2417
Practice Address - Street 1:950 TAYLOR AVE STE 260
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2200
Practice Address - Country:US
Practice Address - Phone:231-329-4262
Practice Address - Fax:888-972-2417
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013905101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6401013905OtherLICENSE