Provider Demographics
NPI:1376783522
Name:VAN DYKE, DINA M (LMHC)
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:M
Last Name:VAN DYKE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8338 COMANCHE RD NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-2304
Mailing Address - Country:US
Mailing Address - Phone:505-323-3665
Mailing Address - Fax:
Practice Address - Street 1:8338 COMANCHE RD NE
Practice Address - Street 2:SUITE B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-2304
Practice Address - Country:US
Practice Address - Phone:505-323-3665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-01
Last Update Date:2009-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-0120911101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health