Healthcare Provider Details

I. General information

NPI: 1235684101
Provider Name (Legal Business Name): COMPLETE CIRCLE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 VT 15
JERICHO VT
05465-4413
US

IV. Provider business mailing address

113 VT 15
JERICHO VT
05465-4413
US

V. Phone/Fax

Practice location:
  • Phone: 802-745-9603
  • Fax:
Mailing address:
  • Phone: 802-745-9603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number104440
License Number StateVT

VIII. Authorized Official

Name: JESSA J CARPENTER
Title or Position: ALCOHOL AND DRUG COUNSELOR
Credential: MS, ADC
Phone: 802-748-5364