| NPI | 1114347440 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLEY THOMPSON BRODIE Officer/Member 802-367-1068 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: VT 042.0012150) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health (Licence: VT 042.0012150) |
| Enumeration Date | 2014-04-25 |
| Last Update Date | 2014-04-25 |