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General NPI Number Information
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NPI Number | 1609173400
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Entity Type | Individual
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Provider Name | CHRISTINE VANDERTOL MFT
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Gender | Female
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Dates
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Enumeration Date | 02/15/2011
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Last Update Date | 03/04/2020
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Provider Practice Location Address
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Address Line | 412 TEAROSE PL SW
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City | LEESBURG
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State | VA
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Zip | 20175-2522
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Country | US
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Telephone | 818-416-5979
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Fax | 818-584-8878
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Provider Business Mailing Address
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Address Line | PO BOX 2902
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City | LEESBURG
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State | VA
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Zip | 20177-7917
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Country | US
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Telephone |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 49416
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 0717001469
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License Number State | VA
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