| NPI | 1104034529 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALBON J COGHLON Owner 802-775-2581 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VT 0680000177) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: VT 5324) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2020-08-22 |