Vicki L Van Deilen, M ED, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC006465 Issued in GA

Practice address

500 E Main St
Suite 302
Blue Ridge, GA 30513-7149

Phone

(419) 351-5111

Fax

(828) 837-8410

NPI assigned

Sep 27, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1317081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317081600000",
    "number": "1568745313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 E MAIN ST",
            "address_2": "SUITE 302",
            "city": "BLUE RIDGE",
            "state": "GA",
            "postal_code": "305137149",
            "telephone_number": "419-351-5111",
            "fax_number": "828-837-8410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 E MAIN ST",
            "address_2": "SUITE 302",
            "city": "BLUE RIDGE",
            "state": "GA",
            "postal_code": "305137149",
            "telephone_number": "419-351-5111",
            "fax_number": "828-837-8410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DEILEN",
        "first_name": "VICKI",
        "middle_name": "L",
        "credential": "M ED, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-09-27",
        "last_updated": "2011-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "GA",
            "license": "LPC006465",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC006465",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "C0900423",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jennifer-Lynn Kaye Waddell

• Professional Counselor in Blue Ridge, GA
• Providers in Blue Ridge, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.