Healthcare Provider Details

I. General information

NPI: 1962737882
Provider Name (Legal Business Name): ANNA REBECCA GRIES B.A, MA, LPC, LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNA HUDSON

II. Dates (important events)

Enumeration Date: 10/09/2009
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 GRANDVIEW TER
RUTLAND VT
05701-3748
US

IV. Provider business mailing address

21 GRANDVIEW TER
RUTLAND VT
05701-3748
US

V. Phone/Fax

Practice location:
  • Phone: 631-766-7897
  • Fax:
Mailing address:
  • Phone: 631-766-7897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0134465
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0011172
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: