Healthcare Provider Details

I. General information

NPI: 1043027154
Provider Name (Legal Business Name): EVE DESJARDINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 12/12/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 NORTH COURT STREET
CHELSEA VT
05038
US

IV. Provider business mailing address

PO BOX 136
CHELSEA VT
05038-0136
US

V. Phone/Fax

Practice location:
  • Phone: 802-685-1065
  • Fax:
Mailing address:
  • Phone: 802-685-1065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0136306
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: