Healthcare Provider Details

I. General information

NPI: 1093839995
Provider Name (Legal Business Name): GAIL POWELL HANSON LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 DORSET ST SUITE #10
SOUTH BURLINGTON VT
05403-6209
US

IV. Provider business mailing address

PO BOX 136
HUNTINGTON VT
05462-0136
US

V. Phone/Fax

Practice location:
  • Phone: 802-654-7607
  • Fax: 802-654-9155
Mailing address:
  • Phone: 802-654-7607
  • Fax: 802-654-9155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0680000402
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: