Healthcare Provider Details

I. General information

NPI: 1679979678
Provider Name (Legal Business Name): MARGARET DUNN LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2014
Last Update Date: 11/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 FOGG FARM ROAD
WILDER VT
05088
US

IV. Provider business mailing address

PO BOX G
RANDOLPH VT
05060-0167
US

V. Phone/Fax

Practice location:
  • Phone: 802-295-1311
  • Fax: 802-295-1312
Mailing address:
  • Phone: 802-728-4466
  • Fax: 802-728-4197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number000638
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: