| NPI | 1679397699 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB EDMONDSON Lcmhc 802-522-8298 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-11-15 |
| Last Update Date | 2024-11-15 |