Provider Demographics
NPI:1831948280
Name:VAN DER WEL, DENISE GABRIELLE (MA, LAC)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:GABRIELLE
Last Name:VAN DER WEL
Suffix:
Gender:F
Credentials:MA, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 THOMAS AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-1030
Mailing Address - Country:US
Mailing Address - Phone:908-797-1173
Mailing Address - Fax:
Practice Address - Street 1:1350 WELSH RD STE 400
Practice Address - Street 2:
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-1923
Practice Address - Country:US
Practice Address - Phone:215-654-9414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00781300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional