Healthcare Provider Details

I. General information

NPI: 1255577714
Provider Name (Legal Business Name): CHRISTOPHER CHADWICK MS, LADC, AFC, CASAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2009
Last Update Date: 05/30/2019
Certification Date:
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 Code101YP2500X
TaxonomyProfessional Counselor
License Number000447
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number000447
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: