Provider Demographics
NPI:1710701206
Name:VANDERHULST, LAURA G (LAC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:G
Last Name:VANDERHULST
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 10TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-5189
Mailing Address - Country:US
Mailing Address - Phone:646-510-5254
Mailing Address - Fax:
Practice Address - Street 1:80 RIVER ST STE 306
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5619
Practice Address - Country:US
Practice Address - Phone:201-565-2275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00646300101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health