| NPI | 1053868976 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLE RAE BERGERON INGRAM CEO 802-353-6580 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: VT 0470111914) |
| Enumeration Date | 2016-09-08 |
| Last Update Date | 2016-09-08 |