Healthcare Provider Details

I. General information

NPI: 1053949875
Provider Name (Legal Business Name): CAITLIN GEORGIA DENNIS-DEVRIES LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2020
Last Update Date: 03/28/2020
Certification Date: 03/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1446 ROUNDS RD
HUNTINGTON VT
05462-9433
US

IV. Provider business mailing address

1446 ROUNDS RD
HUNTINGTON VT
05462-9433
US

V. Phone/Fax

Practice location:
  • Phone: 802-735-3630
  • Fax:
Mailing address:
  • Phone: 802-735-3630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0134208
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: