Provider Demographics
NPI:1679309603
Name:VAN DORF, JOSEPH DANIEL (MA, LPCC)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:DANIEL
Last Name:VAN DORF
Suffix:
Gender:M
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 BRYANT AVE S STE 4
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-2819
Mailing Address - Country:US
Mailing Address - Phone:612-293-9332
Mailing Address - Fax:651-925-0077
Practice Address - Street 1:2012 BRYANT AVE S STE 4
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55405-2819
Practice Address - Country:US
Practice Address - Phone:612-293-9332
Practice Address - Fax:651-925-0077
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4571101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional