Healthcare Provider Details

I. General information

NPI: 1629796594
Provider Name (Legal Business Name): MINDFUL COUNSELING AND MASSAGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2022
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 DORSET ST STE 200
SOUTH BURLINGTON VT
05403-6580
US

IV. Provider business mailing address

359 DORSET ST STE 200
SOUTH BURLINGTON VT
05403-6580
US

V. Phone/Fax

Practice location:
  • Phone: 802-503-5545
  • Fax:
Mailing address:
  • Phone: 802-503-5545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALISSA DUMEER
Title or Position: PARTNER
Credential: LICSW
Phone: 802-503-5545