Provider Demographics
NPI:1215077813
Name:VANDE GARDE, CULLE L (LCSW, CAC)
Entity type:Individual
Prefix:MISS
First Name:CULLE
Middle Name:L
Last Name:VANDE GARDE
Suffix:
Gender:F
Credentials:LCSW, CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4104 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2307
Mailing Address - Country:US
Mailing Address - Phone:913-706-5214
Mailing Address - Fax:
Practice Address - Street 1:4104 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2307
Practice Address - Country:US
Practice Address - Phone:913-706-5214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040091551041C0700X
KS24191041C0700X
CO9925271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical