Healthcare Provider Details

I. General information

NPI: 1013672641
Provider Name (Legal Business Name): JUSTIN DRAGOS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 COLLEGE ST
BURLINGTON VT
05401-8344
US

IV. Provider business mailing address

337 COLLEGE ST
BURLINGTON VT
05401-8344
US

V. Phone/Fax

Practice location:
  • Phone: 802-233-8495
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JUSTIN DRAGOS
Title or Position: LCMHC
Credential: MA, LCMHC
Phone: 802-233-8495