| NPI | 1003564410 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA HUNTER Credentialing Specialist 802-442-5491 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-03-15 |
| Last Update Date | 2022-03-15 |