| NPI | 1891532313 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHAN HASKELL Member 802-917-2836 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2024-07-11 |
| Last Update Date | 2024-08-05 |