Healthcare Provider Details

I. General information

NPI: 1184633810
Provider Name (Legal Business Name): EVITA COBO LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 NORTH ST
BENNINGTON VT
05201-1813
US

IV. Provider business mailing address

1958 MT ANTHONY RD
NORTH POWNAL VT
05260-9720
US

V. Phone/Fax

Practice location:
  • Phone: 802-249-0645
  • Fax: 802-823-5356
Mailing address:
  • Phone: 802-249-0645
  • Fax: 802-823-5356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number068-0000124
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number068-0000124
License Number StateVT
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068-0000124
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: