Healthcare Provider Details

I. General information

NPI: 1801215645
Provider Name (Legal Business Name): ALISON KOPRESKI LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 04/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 JOY DR
SOUTH BURLINGTON VT
05403-6119
US

IV. Provider business mailing address

PO BOX 2226
SOUTH BURLINGTON VT
05407-2226
US

V. Phone/Fax

Practice location:
  • Phone: 802-658-6111
  • Fax:
Mailing address:
  • Phone: 802-658-6111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0078238
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: