Healthcare Provider Details

I. General information

NPI: 1477033207
Provider Name (Legal Business Name): JACQUELINE F ESANCY LADC, LCMHC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 WILSON RD
FAIRFAX VT
05454-4409
US

IV. Provider business mailing address

30 WILSON RD
FAIRFAX VT
05454-4409
US

V. Phone/Fax

Practice location:
  • Phone: 802-255-8801
  • Fax: 802-491-8230
Mailing address:
  • Phone: 802-255-8801
  • Fax: 802-491-8230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number03-997355
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0134335
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number151-0134045
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: