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General NPI Number Information
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NPI Number | 1679349161
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Entity Type | Individual
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Provider Name | MS. TIA GANGULY
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Gender | Female
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Dates
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Enumeration Date | 11/27/2023
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 980 POND BROOK RD
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City | HINESBURG
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State | VT
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Zip | 05461-9027
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Country | US
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Telephone | 802-777-0421
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Fax |
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Provider Business Mailing Address
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Address Line | 34 BLAIR PARK ROAD STE 104 - 248
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City | WILLISTON
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State | VT
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Zip | 05495
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Country | US
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Telephone | 802-777-0421
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 068.0135601
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License Number State | VT
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