Healthcare Provider Details

I. General information

NPI: 1497078695
Provider Name (Legal Business Name): VERMONT CENTER FOR INTEGRATIVE THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2010
Last Update Date: 07/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 DORSET ST SUITE 204
SOUTH BURLINGTON VT
05403-6270
US

IV. Provider business mailing address

364 DORSET ST SUITE 204
SOUTH BURLINGTON VT
05403-6270
US

V. Phone/Fax

Practice location:
  • Phone: 802-658-9440
  • Fax: 802-658-9443
Mailing address:
  • Phone: 802-658-9440
  • Fax: 802-658-9443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE E RUSHFORTH
Title or Position: DIRECTOR OF OPERATIONS
Credential: MACP
Phone: 802-658-9440