Active NPI
Charles John Vanderkolk, PH.D.
- Psychologist
- Weaverville, NC
National Provider Identifier
1700218039
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 2106
- Practice address
- 2 Roberts St
Weaverville, NC 28787-9308 - Phone
- (828) 484-9767
- Fax
- (828) 484-9614
- NPI assigned
- Aug 9, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2106 | NC | Primary |
Addresses
Primary practice location
2 Roberts St
Weaverville, NC 28787-9308
Mailing address
2 Roberts St
Weaverville, NC 28787-9308
Phone (828) 484-9767
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2106 | NC | MD | Intellectual & Developmental Disabilities Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1376006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1376006400000",
"number": "1700218039",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 ROBERTS ST",
"city": "WEAVERVILLE",
"state": "NC",
"postal_code": "287879308",
"telephone_number": "828-484-9767",
"fax_number": "828-484-9614"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 ROBERTS ST",
"city": "WEAVERVILLE",
"state": "NC",
"postal_code": "287879308",
"telephone_number": "828-484-9767",
"fax_number": "828-484-9614"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDERKOLK",
"first_name": "CHARLES",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-08-09",
"last_updated": "2013-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NC",
"license": "2106",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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- Sara Vaughn
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- Jasmine Villarreal, MAOM, DIPL. O.M., L.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.