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General NPI Number Information
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NPI Number | 1699899187
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Entity Type | Organization
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Legal Business Name | NORTHWESTERN COUNSELING & SUPPORT SERVICES
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 11/18/2013
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Provider Practice Location Address
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Address Line | 107 FISHER POND ROAD
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City | SAINT ALBANS
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State | VT
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Zip | 05478-6286
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Country | US
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Telephone | 802-524-6554
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Fax | 802-524-6562
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Provider Business Mailing Address
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Address Line | 107 FISHER POND ROAD
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City | SAINT ALBANS
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State | VT
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Zip | 05478-6286
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Country | US
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Telephone | 802-524-6554
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Fax | 802-524-6562
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. TED JOHN MABLE
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Credential | ED.D.
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Telephone | 802-524-6555
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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 | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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