| NPI | 1972623874 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NORI BOKUM President 802-295-7500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: VT 047-0000634) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: VT 047-0000634) |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: VT 047-0000634) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: VT 047-0000634) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: VT 047-0000634) | |
| 103TF0000X Psychologist, Family (Licence: VT 047-0000634) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: VT 047-0000634) | |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2020-08-22 |