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General NPI Number Information
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NPI Number | 1952024937
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Entity Type | Individual
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Provider Name | GEORGETA BOANCA VANDERMEER M.A
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Gender | Female
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Dates
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Enumeration Date | 09/23/2022
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Last Update Date | 09/23/2022
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Provider Practice Location Address
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Address Line | 3400 SE 196TH AVE STE 102
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City | CAMAS
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State | WA
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Zip | 98607-8862
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Country | US
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Telephone | 360-975-0512
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Fax |
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Provider Business Mailing Address
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Address Line | 6915 SE PLUM DR
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City | MILWAUKIE
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State | OR
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Zip | 97222-2061
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Country | US
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Telephone | 971-222-4938
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | R6643
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License Number State | OR
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