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General NPI Number Information
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NPI Number | 1194572818
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Entity Type | Organization
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Legal Business Name | JACKSON PEAK COUNSELING, PLLC
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Dates
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Enumeration Date | 05/01/2024
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Last Update Date | 05/01/2024
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Provider Practice Location Address
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Address Line | 143 CHURCH ST
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City | DORSET
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State | VT
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Zip | 05251-2001
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Country | US
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Telephone | 802-445-5703
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 56
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City | DORSET
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State | VT
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Zip | 05251-0056
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Country | US
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Telephone | 802-445-5703
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL
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Name | MR. STEPHEN R LONGLEY
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Credential | LICSW
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Telephone | 802-445-5703
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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 |
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License Number State |
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