| NPI | 1255053930 |
|---|---|
| Doing Business As | LODGE PSYCHOTHERAPY |
| Entity Type | Organization |
| Authorized Contact | ALEXANDER LODGE Owner 802-503-2929 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Enumeration Date | 2022-09-19 |
| Last Update Date | 2024-01-31 |