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General NPI Number Information
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NPI Number | 1639832678
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Entity Type | Organization
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Legal Business Name | AT WELLNESS, LLC
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Dates
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Enumeration Date | 10/18/2021
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Last Update Date | 10/18/2021
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Provider Practice Location Address
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Address Line | 358 BAILEY RD
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City | NORTHFIELD
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State | VT
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Zip | 05663-0566
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Country | US
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Telephone | 802-498-8384
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 242
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City | NORTHFIELD
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State | VT
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Zip | 05663-0242
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Country | US
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Telephone | 802-498-8384
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | KATHARINE MORRIS
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Credential | LICSW
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Telephone | 802-498-8384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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