Healthcare Provider Details

I. General information

NPI: 1871458430
Provider Name (Legal Business Name): MARK JAMES WASHENBERGER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 LAKE ST # 301
BURLINGTON VT
05401-5297
US

IV. Provider business mailing address

86 LAKE ST # 301
BURLINGTON VT
05401-5297
US

V. Phone/Fax

Practice location:
  • Phone: 802-324-8984
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number097.0135505
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: