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Individual
MR. MARK E VANTUYL
Active
Individual
MR. MARK E VANTUYL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPCS, LCAS, CCS
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CCS-1553
NC
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCAS-205930
NC
101YM0800X
Mental Health Counselor
Primary
LPCS-S7461
NC
Other
Enumeration date
09/10/2008
Last updated
06/12/2013
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