Provider Demographics
NPI:1982035788
Name:VANDENBERGH, VIRGINIA PLEASANTS (LMFT)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:PLEASANTS
Last Name:VANDENBERGH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4760 LUDLOW ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-6742
Mailing Address - Country:US
Mailing Address - Phone:510-735-6002
Mailing Address - Fax:
Practice Address - Street 1:4760 LUDLOW ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305
Practice Address - Country:US
Practice Address - Phone:510-735-6002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-03
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001419101YM0800X
VT100.0093081101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health