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General NPI Number Information
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NPI Number | 1154871630
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Entity Type | Organization
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Legal Business Name | QUAIL HOLLOW COUNSELING LLC
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Dates
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Enumeration Date | 10/10/2016
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Last Update Date | 10/10/2016
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Provider Practice Location Address
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Address Line | 4 MERRILL LN UNIT 102
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City | MILTON
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State | VT
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Zip | 05468-3322
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Country | US
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Telephone | 802-559-0255
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Fax |
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Provider Business Mailing Address
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Address Line | 4 MERRILL LN UNIT 102
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City | MILTON
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State | VT
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Zip | 05468-3322
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/LICSW
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Name | MEGHAN LEWELLEN
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Credential |
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Telephone | 802-559-0255
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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 | 089.0097508
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License Number State | VT
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