Healthcare Provider Details

I. General information

NPI: 1164556726
Provider Name (Legal Business Name): SPECTRUM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 PINE ST FL 2
BURLINGTON VT
05401-4441
US

IV. Provider business mailing address

31 ELMWOOD AVE
BURLINGTON VT
05401-4347
US

V. Phone/Fax

Practice location:
  • Phone: 802-864-7423
  • Fax: 833-857-8969
Mailing address:
  • Phone: 802-864-7423
  • Fax: 802-660-0576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MICHAEL GRANT
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CPA
Phone: 802-864-7423