MEDICARE: CAROL VANDYKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	6401007473	MI

General Provider Information

NPI Number	:	1376616086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL VANDYKE

Provider Business Mailing Address
First Line	:	31584 SCHOOLCRAFT RD
Second Line	:
City	:	LIVONIA
State	:	MI
Zip	:	48150-1805
Country	:	US
Telephone Number	:	734-266-1335
Fax Number	:	734-427-0060

Provider Business Practice Location Address
First Line	:	31584 SCHOOLCRAFT RD
Second Line	:
City	:	LIVONIA
State	:	MI
Zip	:	48150-1805
Country	:	US
Telephone Number	:	734-266-1335
Fax Number	:	734-427-0060

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	01/31/2024

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Directions to “ CAROL VANDYKE ” Practice Location

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