Healthcare Provider Details

I. General information

NPI: 1336278985
Provider Name (Legal Business Name): COUNSELING SERVICE OF ADDISON COUNTY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 MAIN ST
MIDDLEBURY VT
05753-1459
US

IV. Provider business mailing address

89 MAIN ST
MIDDLEBURY VT
05753-1459
US

V. Phone/Fax

Practice location:
  • Phone: 802-388-6751
  • Fax: 802-388-8183
Mailing address:
  • Phone: 802-388-6751
  • Fax: 802-388-8183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EMILY ANN VANDEWEERT
Title or Position: BILLING MANAGER
Credential:
Phone: 802-388-6751