Individual
MICHAEL ALLEN VANSLYKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BA, LISAC
Contact information
Practice address
6540 N CHOLLA LN, CASA GRANDE, AZ 85194-6896
(520) 836-1675
Mailing address
6540 N CHOLLA LN, CASA GRANDE, AZ 85194-6896
(520) 836-1675
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LISAC-10197
AZ
Other
Enumeration date
06/18/2010
Last updated
06/18/2010
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