Healthcare Provider Details

I. General information

NPI: 1871764076
Provider Name (Legal Business Name): NORMA JEAN VAN VOLKINBURG PSYCHOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date: 05/07/2010
Reactivation Date: 12/29/2010

III. Provider practice location address

101 BODIN CIR
TRAVIS AFB CA
94535-1809
US

IV. Provider business mailing address

101 BODIN CIR
TRAVIS AFB CA
94535-1809
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-5174
  • Fax:
Mailing address:
  • Phone: 707-423-5174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number17186
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY#17186
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: