Healthcare Provider Details

I. General information

NPI: 1619676442
Provider Name (Legal Business Name): NANCY DALE VANDERROEST LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 E COLBY ST
WHITEHALL MI
49461-1113
US

IV. Provider business mailing address

516 E COLBY ST
WHITEHALL MI
49461-1113
US

V. Phone/Fax

Practice location:
  • Phone: 231-893-8336
  • Fax: 231-981-5277
Mailing address:
  • Phone: 231-893-8336
  • Fax: 231-981-5277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451016164
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: