| NPI | 1386099059 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWN MICHAEL WALDRON Owner/Provider 802-745-9567 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VT 068.0069442) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VT 000644) |
| Enumeration Date | 2016-04-29 |
| Last Update Date | 2016-04-29 |