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General NPI Number Information
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NPI Number | 1003604471
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Entity Type | Individual
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Provider Name | LYDIA SLOCUM RUSSELL LCMHC
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Gender | Female
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Dates
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Enumeration Date | 04/28/2025
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Last Update Date | 05/26/2025
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Provider Practice Location Address
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Address Line | 132 MAIN ST STE 2
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City | MONTPELIER
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State | VT
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Zip | 05602-3226
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Country | US
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Telephone | 802-461-8269
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Fax | 802-461-8269
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Provider Business Mailing Address
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Address Line | 1100 FOSTER HILL RD
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City | EAST CALAIS
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State | VT
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Zip | 05650-8009
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Country | US
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Telephone | 802-456-1098
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 068.0136566
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License Number State | VT
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