Healthcare Provider Details

I. General information

NPI: 1487519724
Provider Name (Legal Business Name): COUNSELOR GREY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 HERCULES DR STE 1A
COLCHESTER VT
05446-8113
US

IV. Provider business mailing address

525 HERCULES DR STE 1A
COLCHESTER VT
05446-8113
US

V. Phone/Fax

Practice location:
  • Phone: 802-264-5333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: LINCOLN GREY
Title or Position: OWNER
Credential: MA
Phone: 802-264-5333