Provider Demographics
NPI:1700997178
Name:VODUSEK, MICHAEL JOSEPH (LPC, CADC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:VODUSEK
Suffix:
Gender:M
Credentials:LPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:NORTH EAST
Mailing Address - State:PA
Mailing Address - Zip Code:16428-1333
Mailing Address - Country:US
Mailing Address - Phone:814-347-5018
Mailing Address - Fax:
Practice Address - Street 1:110 E MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:PA
Practice Address - Zip Code:16428-1333
Practice Address - Country:US
Practice Address - Phone:814-347-5018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA16438101YA0400X
101YM0800X, 101YA0400X
PAPC013673101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA16438OtherPA CERTIFICATION BOARD- CADC
PAPC013678OtherLICENSED PROFESSIONAL COUNSELOR