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General NPI Number Information
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NPI Number | 1477033207
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Entity Type | Individual
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Provider Name | JACQUELINE F ESANCY LADC, LCMHC, LPC
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Gender | Female
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Dates
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Enumeration Date | 08/21/2018
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Last Update Date | 04/01/2024
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Provider Practice Location Address
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Address Line | 30 WILSON RD
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City | FAIRFAX
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State | VT
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Zip | 05454-4409
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Country | US
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Telephone | 802-255-8801
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Fax | 802-491-8230
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Provider Business Mailing Address
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Address Line | 30 WILSON RD
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City | FAIRFAX
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State | VT
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Zip | 05454-4409
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Country | US
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Telephone | 802-255-8801
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Fax | 802-491-8230
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 03-997355
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License Number State | CT
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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 | 068.0134335
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License Number State | VT
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 151-0134045
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License Number State | VT
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