Provider Demographics
NPI:1518116920
Name:VANTUYL, MARK E (LPCS, LCAS, CCS)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:E
Last Name:VANTUYL
Suffix:
Gender:M
Credentials:LPCS, LCAS, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 CLOVER MOUNTAIN LN
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-8857
Mailing Address - Country:US
Mailing Address - Phone:828-458-2878
Mailing Address - Fax:
Practice Address - Street 1:14 CLOVER MOUNTAIN LN
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-8857
Practice Address - Country:US
Practice Address - Phone:828-458-2878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCCS-1553101YA0400X
NCLPCS-S7461101YM0800X
NCLCAS-205930101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)