Provider Demographics
NPI:1235402587
Name:VANDENBERGH, JOEL DAVID (LPC)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:DAVID
Last Name:VANDENBERGH
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 W BROAD AVE
Mailing Address - Street 2:SUITE C-6
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-4397
Mailing Address - Country:US
Mailing Address - Phone:229-430-0416
Mailing Address - Fax:229-430-2956
Practice Address - Street 1:601 11TH AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1645
Practice Address - Country:US
Practice Address - Phone:229-430-4140
Practice Address - Fax:229-430-4059
Is Sole Proprietor?:No
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006611101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional