Individual
MICHAEL LEE VAN DAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
94 E PAGES LN, SUITE A, CENTERVILLE, UT 84014-2216
(801) 294-0578
Mailing address
94 E PAGES LN, SUITE A, CENTERVILLE, UT 84014-2216
(801) 294-0578
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
5199130-3501
UT
Other
Enumeration date
10/25/2006
Last updated
06/23/2009
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