Healthcare Provider Details

I. General information

NPI: 1083997563
Provider Name (Legal Business Name): FORENSIC CONSULTATION & COUNSELING SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2011
Last Update Date: 01/06/2022
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 GRANGER ST
RUTLAND VT
05701-4405
US

IV. Provider business mailing address

135 GRANGER ST
RUTLAND VT
05701-4405
US

V. Phone/Fax

Practice location:
  • Phone: 802-772-0700
  • Fax: 802-771-8009
Mailing address:
  • Phone: 802-772-0700
  • Fax: 802-771-8009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0047526
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number000447
License Number StateVT
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number000447
License Number StateVT

VIII. Authorized Official

Name: MR. CHRISTOPHER CHADWICK
Title or Position: DIRECTOR
Credential: MS LADC AFC
Phone: 802-772-0700