Healthcare Provider Details

I. General information

NPI: 1568366417
Provider Name (Legal Business Name): HOLLIS ANDREW EASTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 CHERRY LN
BURLINGTON VT
05401-4907
US

IV. Provider business mailing address

PO BOX 1242
BURLINGTON VT
05402-1242
US

V. Phone/Fax

Practice location:
  • Phone: 802-448-2258
  • Fax:
Mailing address:
  • Phone: 802-448-2258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number097.0134685
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: