Healthcare Provider Details

I. General information

NPI: 1962139717
Provider Name (Legal Business Name): YOUR SEASON COUNSELING, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 BRAEBURN ST
SOUTH BURLINGTON VT
05403-4471
US

IV. Provider business mailing address

93 BRAEBURN ST
SOUTH BURLINGTON VT
05403-4471
US

V. Phone/Fax

Practice location:
  • Phone: 802-355-9633
  • Fax: 802-399-2144
Mailing address:
  • Phone: 802-355-9633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. SHARON L DAVIS
Title or Position: DIRECTOR
Credential: MSW, LICSW
Phone: 802-355-9633