Doctor Name: | MS. ELISE MARITA VANDAMIA |
NPI Number: | 1245645571 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, LPC |
License Number: | PC006158 |
Business Practice Address: | 316 Station St Bridgeville, PA - 150171833 |
Business Phone Number: | 4122211091 |
Business Fax Number: | |
Mailing Address: | 807 Windover Dr, OAKDALE |
State: | PA |
Postal Code: | 150719395 |
Phone Number: | 4127229923 |
Fax Number: | |
NPI Enumeration Date: | 06/25/2014 |
NPI Last Update Date: | 06/25/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | PC006158 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |