Provider Demographics
NPI:1871764076
Name:VAN VOLKINBURG, NORMA JEAN (PSYCHOLOGIST)
Entity type:Individual
Prefix:DR
First Name:NORMA
Middle Name:JEAN
Last Name:VAN VOLKINBURG
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BODIN CIR
Mailing Address - Street 2:
Mailing Address - City:TRAVIS AFB
Mailing Address - State:CA
Mailing Address - Zip Code:94535-1809
Mailing Address - Country:US
Mailing Address - Phone:707-423-5174
Mailing Address - Fax:
Practice Address - Street 1:101 BODIN CIR
Practice Address - Street 2:
Practice Address - City:TRAVIS AFB
Practice Address - State:CA
Practice Address - Zip Code:94535-1809
Practice Address - Country:US
Practice Address - Phone:707-423-5174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2023-08-07
Deactivation Date:2010-05-07
Deactivation Code:
Reactivation Date:2010-12-29
Provider Licenses
StateLicense IDTaxonomies
CA17186103TC0700X
CAPSY#17186103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical