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General NPI Number Information
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NPI Number | 1104314269
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Entity Type | Organization
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Legal Business Name | OPEN HEART COUNSELING PLC
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Dates
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Enumeration Date | 04/24/2018
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Last Update Date | 04/24/2018
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Provider Practice Location Address
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Address Line | 160 RIVER ST UNIT 103
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City | MILTON
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State | VT
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Zip | 05468-3662
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Country | US
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Telephone | 802-310-7091
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Fax |
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Provider Business Mailing Address
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Address Line | 160 RIVER ST UNIT 103
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City | MILTON
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State | VT
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Zip | 05468-3662
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Country | US
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Telephone | 802-310-7091
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER/OWNER
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Name | JULIA KIMBALL
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Credential |
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Telephone | 802-310-7091
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 089.0084650
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License Number State | VT
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