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General NPI Number Information
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NPI Number | 1760815443
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Entity Type | Individual
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Provider Name | SHAWN M WALDRON MA, LCMHC, LADC, NCC
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Gender | Male
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Dates
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Enumeration Date | 08/16/2013
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Last Update Date | 11/29/2022
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Provider Practice Location Address
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Address Line | 45 CENTER ST
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City | SUTTON
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State | VT
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Zip | 05867-9705
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Country | US
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Telephone | 802-745-9567
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Fax | 802-533-2044
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Provider Business Mailing Address
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Address Line | 45 CENTER ST
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City | SUTTON
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State | VT
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Zip | 05867-9705
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Country | US
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Telephone | 802-745-9567
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Fax | 802-533-2044
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 000644
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0680069442
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License Number State | VT
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 151.0127299
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License Number State | VT
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