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General NPI Number Information
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NPI Number | 1922106970
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Entity Type | Individual
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Provider Name | COLLIN J. VANDER POL LCSW
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/19/2012
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Provider Practice Location Address
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Address Line | 81 CROWN MOUNTAIN PL SUITE A-300
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City | DAHLONEGA
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State | GA
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Zip | 30533-1627
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Country | US
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Telephone | 706-867-0566
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Fax | 706-867-6859
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Provider Business Mailing Address
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Address Line | PO BOX 1693
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City | DAHLONEGA
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State | GA
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Zip | 30533-0029
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Country | US
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Telephone | 706-867-0566
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Fax | 706-867-6859
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW003570
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License Number State | GA
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