Individual
JOHN VANDEGRIFT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, CAC I
Contact information
Practice address
709 3RD AVE, LONGMONT, CO 80501-5926
(970) 281-7872
Mailing address
709 3RD AVE, LONGMONT, CO 80501-5926
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
ACA.0007475
CO
Other
Enumeration date
12/31/2019
Last updated
12/31/2019
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