| NPI | 1003315177 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VINCENT BUCKHOLZ Owner 802-692-0697 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: VT 0890114807) |
| Enumeration Date | 2018-02-05 |
| Last Update Date | 2018-02-05 |