Individual ProviderGina Nicole Bartucca Van DykenCounselorBehavioral Health & Social Service ProvidersPractice Address1601 E Fourth Plain Blvd Bldg 17, Vancouver, WA 98661-3717(360) 397-8246PECOS EnrollmentBased on the most recent information from CMS, provider Gina Nicole Bartucca Van Dyken does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 10:04 AM.Profile DetailsProvider ID1659975787Provider TypeIndividualFull NameBartucca Van Dyken, Gina NicoleCredentialMSWGenderFemaleSole ProprietorNoEnumeration Date11/30/2020Last Updated11/30/2020Contact InformationPractice LocationPractice Address1601 E Fourth Plain Blvd Bldg 17, Vancouver, WA 98661-3717Phone(360) 397-8246Fax(360) 397-8250Mailing LocationMailing AddressPO Box 1678, Vancouver, WA 98668-1678PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseCG61112274Washington