| NPI | 1508936238 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FAVOR ELLIS Executive Director 802-229-9151 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VT 000350) |
| 103T00000X Psychologist (Licence: VT 0470000720) | |
| 1041C0700X Social Worker, Clinical (Licence: VT 0890000651) | |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2024-11-26 |