Healthcare Provider Details

I. General information

NPI: 1942572235
Provider Name (Legal Business Name): SANDRA A COTTER LCMHC, MLADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2012
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL CT
BELLOWS FALLS VT
05101-1489
US

IV. Provider business mailing address

1 HOSPITAL CT
BELLOWS FALLS VT
05101-1489
US

V. Phone/Fax

Practice location:
  • Phone: 802-463-1292
  • Fax: 802-463-9588
Mailing address:
  • Phone: 802-463-1292
  • Fax: 802-463-9588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number000443
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0680069447
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: