| NPI | 1942738695 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAVEL MALM Owner / Director 802-327-0077 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VT 068-0000594) |
| Enumeration Date | 2017-05-25 |
| Last Update Date | 2021-05-18 |