| NPI | 1669498853 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER MARY FAUNTLEROY Owner 802-775-1398 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VT 042-0009568) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2020-08-22 |