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General NPI Number Information
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NPI Number | 1083997563
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Entity Type | Organization
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Legal Business Name | FORENSIC CONSULTATION & COUNSELING SERVICE
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Dates
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Enumeration Date | 09/21/2011
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Last Update Date | 01/06/2022
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Provider Practice Location Address
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Address Line | 135 GRANGER ST
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City | RUTLAND
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State | VT
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Zip | 05701-4405
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Country | US
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Telephone | 802-772-0700
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Fax | 802-771-8009
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Provider Business Mailing Address
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Address Line | 135 GRANGER ST
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City | RUTLAND
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State | VT
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Zip | 05701-4405
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Country | US
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Telephone | 802-772-0700
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Fax | 802-771-8009
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. CHRISTOPHER CHADWICK
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Credential | MS LADC AFC
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Telephone | 802-772-0700
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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 | 068.0047526
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 000447
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License Number State | VT
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 000447
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License Number State | VT
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