Provider Demographics
NPI:1326676859
Name:VAN DYKE, ALEXANDRA N
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:N
Last Name:VAN DYKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 FELTA RD
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-9425
Mailing Address - Country:US
Mailing Address - Phone:707-239-6990
Mailing Address - Fax:
Practice Address - Street 1:1550 N DUTTON AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4601
Practice Address - Country:US
Practice Address - Phone:707-236-6696
Practice Address - Fax:707-236-6695
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health