| Doctor Name: | DR. VLADIMIR ROBERT JAMES VANDALOV |
| NPI Number: | 1013976182 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PSYD |
| License Number: | 6401005273 |
| Business Practice Address: | 10 W Square Lake Rd Suite 101 Bloomfield Hills, MI - 483020466 |
| Business Phone Number: | 2489900140 |
| Business Fax Number: | 8885109669 |
| Mailing Address: | 10 W Square Lake Rd, Suite 101 BLOOMFIELD HILLS |
| State: | MI |
| Postal Code: | 483020466 |
| Phone Number: | 2489900140 |
| Fax Number: | 8885109669 |
| NPI Enumeration Date: | 03/18/2006 |
| NPI Last Update Date: | 07/21/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 6401005273 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |