Healthcare Provider Details

I. General information

NPI: 1558856203
Provider Name (Legal Business Name): WILLIAM VANDYKE, JR. LCDCII, AND QMHSIII
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 S HAWKINS AVE
AKRON OH
44320
US

IV. Provider business mailing address

1735 S HAWKINS AVE
AKRON OH
44320-3902
US

V. Phone/Fax

Practice location:
  • Phone: 330-867-5400
  • Fax: 330-869-8263
Mailing address:
  • Phone: 330-867-5400
  • Fax: 330-869-8263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number3995
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDCII.162261
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number060271
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: