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General NPI Number Information
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NPI Number | 1538858352
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Entity Type | Organization
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Legal Business Name | ROSE PONEY COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 05/08/2023
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Last Update Date | 05/08/2023
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Provider Practice Location Address
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Address Line | 1070 W MAIN ST STE 5
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City | RICHMOND
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State | VT
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Zip | 05477-9850
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Country | US
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Telephone | 802-310-0770
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Fax |
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Provider Business Mailing Address
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Address Line | 548 MOUNTAINVIEW DR
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City | WATERBURY
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State | VT
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Zip | 05676-9122
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Country | US
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Telephone | 802-310-0770
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROSE PONEY
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Credential | LCMHC
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Telephone | 802-310-0770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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