Individual
NICHOLAS VAN WALLEGHEM
Active
Individual
NICHOLAS VAN WALLEGHEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
2019026772
MO
1041C0700X
Clinical Social Worker
Primary
2022001668
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
490096849
—
MO
Enumeration date
04/12/2021
Last updated
08/08/2022
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