Healthcare Provider Details

I. General information

NPI: 1427129857
Provider Name (Legal Business Name): ED M WILLIAMSON LCMHC/LADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: EDWARD HAMMER WILLIAMSON LCMHC/LADC

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 05/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 FAIRFIELD ST
SAINT ALBANS VT
05478-1743
US

IV. Provider business mailing address

208 FLYNN AVE 3-J
BURLINGTON VT
05401-5429
US

V. Phone/Fax

Practice location:
  • Phone: 802-488-6265
  • Fax: 802-488-6919
Mailing address:
  • Phone: 802-488-6900
  • Fax: 802-488-6919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068-0000423
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0001000
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: