| Doctor Name: | MR. DAVID ALAN VANDERWAL |
| NPI Number: | 1104004712 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MA/LPC |
| License Number: | 6401005560 |
| Business Practice Address: | 6670 Kalamazoo Ave Se Suite D Kentwood, MI - 495087856 |
| Business Phone Number: | 6165654159 |
| Business Fax Number: | 6165654161 |
| Mailing Address: | 207 Sunnyview Dr Sw, GRANDVILLE |
| State: | MI |
| Postal Code: | 494182129 |
| Phone Number: | 6164572277 |
| Fax Number: | |
| NPI Enumeration Date: | 02/06/2008 |
| NPI Last Update Date: | 02/06/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 6401005560 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |