Provider Demographics
NPI:1316216732
Name:VANDYKE, ANDREW D (LPC, CGP)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:D
Last Name:VANDYKE
Suffix:
Gender:M
Credentials:LPC, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 W CUCHARRAS ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-4336
Mailing Address - Country:US
Mailing Address - Phone:719-659-6228
Mailing Address - Fax:
Practice Address - Street 1:1118 W CUCHARRAS ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-4336
Practice Address - Country:US
Practice Address - Phone:719-659-6228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC-6331101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO27001784Medicaid