| NPI | 1023235470 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDMUND H MOORE CFO 802-886-4567 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2019-04-03 |