Healthcare Provider Details

I. General information

NPI: 1598354680
Provider Name (Legal Business Name): DAN VROEGOP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2021
Last Update Date: 01/13/2021
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2280 W WILLIAM ST
DELAWARE OH
43015-1362
US

IV. Provider business mailing address

618 ACME RD
DELAWARE OH
43015-2226
US

V. Phone/Fax

Practice location:
  • Phone: 740-361-4558
  • Fax:
Mailing address:
  • Phone: 740-361-4558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2103094
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: