Healthcare Provider Details

I. General information

NPI: 1386255107
Provider Name (Legal Business Name): COUNSELING FOR CHANGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2020
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 PINNACLE RDG
UNDERHILL VT
05489-4411
US

IV. Provider business mailing address

22 PINNACLE RDG
UNDERHILL VT
05489-4411
US

V. Phone/Fax

Practice location:
  • Phone: 318-523-0523
  • Fax:
Mailing address:
  • Phone: 318-523-0523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ANDREW E. SEGUEL
Title or Position: OWNER / COUNSELOR
Credential: MS, LPC, NCC, CCSCC
Phone: 318-523-0523