Individual
MR. MARK ANTHONY VAN DYKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2250 N CRAYCROFT RD, SUITE 250, TUCSON, AZ 85712-2802
(520) 546-4452
(520) 546-4494
Mailing address
2250 N CRAYCROFT RD, SUITE 250, TUCSON, AZ 85712-2802
(520) 546-4452
(520) 546-4494
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-3537
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
883729
AHCCCS
AZ
Enumeration date
09/29/2006
Last updated
07/08/2007
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