Healthcare Provider Details

I. General information

NPI: 1477464360
Provider Name (Legal Business Name): LISA GOULETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 S MAIN ST
SAINT ALBANS VT
05478-1801
US

IV. Provider business mailing address

36 SHORE RD
MILTON VT
05468-3500
US

V. Phone/Fax

Practice location:
  • Phone: 802-370-3545
  • Fax: 802-524-0055
Mailing address:
  • Phone: 802-922-1064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number149.0134041
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: