Provider Demographics
NPI:1679299929
Name:VANDENBERG, ELISABETH JOY (MA, LLPC)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:JOY
Last Name:VANDENBERG
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:ELISABETH
Other - Middle Name:
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:372 BEACON LIGHT CIR APT 306
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-8113
Mailing Address - Country:US
Mailing Address - Phone:231-721-5557
Mailing Address - Fax:
Practice Address - Street 1:890 WASHINGTON AVE STE 150
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-7702
Practice Address - Country:US
Practice Address - Phone:616-952-9957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451022559101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health