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General NPI Number Information
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NPI Number | 1649931874
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Entity Type | Organization
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Legal Business Name | SPROUT SUPPORTIVE COUNSELING LLC
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Dates
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Enumeration Date | 01/10/2022
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Last Update Date | 01/10/2022
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Provider Practice Location Address
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Address Line | 337 COLLEGE ST STE 302
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City | BURLINGTON
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State | VT
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Zip | 05401-8344
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Country | US
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Telephone | 802-391-9514
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 101
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City | WINOOSKI
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State | VT
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Zip | 05404-0101
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Country | US
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Telephone | 802-391-9514
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Fax |
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Authorized Official
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Title or Position | CLINICIAN
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Name | LAUREN GIUMARRA
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Credential | LICSW
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Telephone | 802-391-9514
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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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Taxonomy #2
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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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