| NPI | 1013422781 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNEMARIE DUBOIS Therapist 802-999-4559 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: MT SWP-LCSW-LIC-4591) |
| Additional Taxonomies | 261QM0850X Clinic/Center Adult Mental Health (Licence: MT SWP-LCSW-LIC-4591) |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health (Licence: MT SWP-LCSW-LIC-4591) | |
| Enumeration Date | 2017-12-04 |
| Last Update Date | 2017-12-04 |