Individual
MR. DOUGLAS A VANTASSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CASAC-T
Contact information
Practice address
5 PENFIELD DR, EAST NORTHPORT, NY 11731-4901
(631) 239-5071
(631) 239-5071
Mailing address
5 PENFIELD DR, EAST NORTHPORT, NY 11731-4901
(631) 239-5071
(631) 239-5071
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
11/07/2016
Last updated
11/07/2016
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