Provider Demographics
NPI:1821758327
Name:VANDENHEUVEL, BREANNA M (CDCA)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:M
Last Name:VANDENHEUVEL
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 CLIME RD STE 130
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-6492
Mailing Address - Country:US
Mailing Address - Phone:614-363-4489
Mailing Address - Fax:
Practice Address - Street 1:4300 CLIME RD STE 130
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-6492
Practice Address - Country:US
Practice Address - Phone:614-363-4489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-23
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.179087101YA0400X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)