| NPI | 1104790039 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELIQUE RAFFINEE LAWSON Provider 802-239-6065 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-10-02 |
| Last Update Date | 2025-10-02 |