Provider Demographics
NPI:1477607646
Name:VANDEVERT, DAVID ARTHUR (MS, MFT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ARTHUR
Last Name:VANDEVERT
Suffix:
Gender:M
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 THE ALAMEDA
Mailing Address - Street 2:SUITE 24
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94707-2310
Mailing Address - Country:US
Mailing Address - Phone:510-524-5946
Mailing Address - Fax:
Practice Address - Street 1:925 THE ALAMEDA
Practice Address - Street 2:SUITE 24
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94707-2310
Practice Address - Country:US
Practice Address - Phone:510-524-5946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37501106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist