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General NPI Number Information
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NPI Number | 1043935687
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Entity Type | Individual
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Provider Name | DEBRA L VANDENBOOM MAPCC LPC
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Gender | Female
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Dates
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Enumeration Date | 10/06/2022
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Last Update Date | 06/25/2024
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Provider Practice Location Address
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Address Line | 80 ELKENBURG ST
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City | SOUTH HAVEN
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State | MI
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Zip | 49090-1275
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Country | US
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Telephone | 269-205-3502
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Fax |
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Provider Business Mailing Address
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Address Line | 2900 CLEVELAND AVE APT 212
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-2364
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Country | US
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Telephone | 262-325-7424
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6451020862
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6401224288
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License Number State | MI
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