=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700244100
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNELLE ALVIN MS LCMHC LADC NCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2016
-----------------------------------------------------
Last Update Date | 01/21/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 133 ELM ST
-----------------------------------------------------
City | MONTPELIER
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05602-3233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-552-8622
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1075
-----------------------------------------------------
City | MONTPELIER
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05601-1075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-345-5630
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 000700
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 068.0117881
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------