Healthcare Provider Details

I. General information

NPI: 1447289541
Provider Name (Legal Business Name): VICTORIA E COLVIN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 PINE ST
BURLINGTON VT
05401-4924
US

IV. Provider business mailing address

142 CREEKSIDE DR
SHELBURNE VT
05482-7567
US

V. Phone/Fax

Practice location:
  • Phone: 802-862-6459
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number000049
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089-0000104
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: