Doctor Name: | CHRISTOPHER VAN DYKE |
NPI Number: | 1104963438 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MA |
License Number: | |
Business Practice Address: | 1909 Commerce Ave Cullman, AL - 350556151 |
Business Phone Number: | 2567344688 |
Business Fax Number: | 2567365638 |
Mailing Address: | 1007 Maple Dr Nw, CULLMAN |
State: | AL |
Postal Code: | 350552317 |
Phone Number: | 2567393409 |
Fax Number: | |
NPI Enumeration Date: | 01/30/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |