Provider Demographics
NPI:1285942755
Name:VANDECAVEYE, ALICE MARGARET (LISW)
Entity type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:MARGARET
Last Name:VANDECAVEYE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W WAYNE ST STE 4
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-2156
Mailing Address - Country:US
Mailing Address - Phone:419-276-0117
Mailing Address - Fax:
Practice Address - Street 1:210 W WAYNE ST STE 4
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-2156
Practice Address - Country:US
Practice Address - Phone:419-276-0117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-18
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OHI.12010791041C0700X
OHI.1201079-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health