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General NPI Number Information
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NPI Number | 1205552031
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Entity Type | Organization
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Legal Business Name | INDIVIDUAL & FAMILY COUNSELING CLINIC FOR HEALING & CHANGE PROFES
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Dates
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Enumeration Date | 10/13/2022
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 9854 NEW HOPE RD
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City | GALT
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State | CA
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Zip | 95632-8807
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Country | US
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Telephone | 209-406-0445
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Fax |
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Provider Business Mailing Address
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Address Line | 9854 NEW HOPE RD
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City | GALT
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State | CA
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Zip | 95632-8807
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Country | US
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Telephone | 209-406-0445
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTINE LINDSAY VANDEKERCKHOVE
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Credential |
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Telephone | 217-415-4754
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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 |
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License Number State |
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