Individual
ROBIN GENE VANDEVENTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2200 LAKE AVE STE 225, FORT WAYNE, IN 46805-5364
(260) 436-0932
(260) 436-1185
Mailing address
240 N TILLOTSON AVE, MUNCIE, IN 47304-3988
(765) 288-1928
(765) 741-0335
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
88000671A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14329568
CAQH
—
01
—
88000671A
MENTAL HEALTH ASSOCIATE LICENSE
IN
Enumeration date
09/18/2018
Last updated
09/18/2018
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