Provider Demographics
NPI:1730660077
Name:VANDAELE, ANASTASIA L
Entity type:Individual
Prefix:MS
First Name:ANASTASIA
Middle Name:L
Last Name:VANDAELE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANASTASIA
Other - Middle Name:
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC-C, MA, MS
Mailing Address - Street 1:15 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:WHITEFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03598-3114
Mailing Address - Country:US
Mailing Address - Phone:603-991-5349
Mailing Address - Fax:
Practice Address - Street 1:400 AMHERST ST STE 200
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-4223
Practice Address - Country:US
Practice Address - Phone:603-889-3553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1010101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health