Provider Demographics
NPI:1972873776
Name:VANDENBERG, JOANNE BETH (MA, LLP)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:BETH
Last Name:VANDENBERG
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1243 EUNA VISTA CT
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-6608
Mailing Address - Country:US
Mailing Address - Phone:616-796-0302
Mailing Address - Fax:
Practice Address - Street 1:1243 EUNA VISTA CT
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-6608
Practice Address - Country:US
Practice Address - Phone:616-796-0302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009812101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health