Provider Demographics
NPI:1558119131
Name:VAN DYKE, CHRISTOPHER S (LCMHCA)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:S
Last Name:VAN DYKE
Suffix:
Gender:M
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 PUG RUN
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-7709
Mailing Address - Country:US
Mailing Address - Phone:828-273-4852
Mailing Address - Fax:
Practice Address - Street 1:2 S MAIN ST STE 24
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-8473
Practice Address - Country:US
Practice Address - Phone:828-713-2131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19684101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health