Provider Demographics
NPI:1699979799
Name:VANDE VREDE, NANCY J (MA, LPC NCC)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:VANDE VREDE
Suffix:
Gender:F
Credentials:MA, LPC NCC
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:J
Other - Last Name:VANDE VREDE-TILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA LPC NCC
Mailing Address - Street 1:1201 NICKERSON CT
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-2423
Mailing Address - Country:US
Mailing Address - Phone:269-925-6995
Mailing Address - Fax:269-925-6959
Practice Address - Street 1:1201 NICKERSON CT
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-2423
Practice Address - Country:US
Practice Address - Phone:269-925-6995
Practice Address - Fax:269-925-6959
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006575101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional