Individual
TIM S. VANDERGAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, NCC
Contact information
Practice address
952 COPPERFIELD BLVD NE, CONCORD, NC 28025-2433
(704) 786-7709
Mailing address
3967 TENNEYSON CT, CONCORD, NC 28027-8119
(704) 210-8450
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
45941
NC
Other
Enumeration date
05/29/2007
Last updated
07/08/2007
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