Provider Demographics
NPI:1851553853
Name:VANDYKE, EDWARD CLAYTON (LMHC)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:CLAYTON
Last Name:VANDYKE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WILLIAMS ST FL 2
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-1706
Mailing Address - Country:US
Mailing Address - Phone:315-527-6062
Mailing Address - Fax:
Practice Address - Street 1:2 WILLIAMS ST FL 2
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323-1706
Practice Address - Country:US
Practice Address - Phone:315-527-6062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001000 1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health