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General NPI Number Information
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NPI Number | 1811417256
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Entity Type | Individual
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Provider Name | THOMAS J HALLIGAN JR.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2017
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Last Update Date | 06/27/2017
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Provider Practice Location Address
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Address Line | 181 CRAWFORD ROAD
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City | DERBY
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State | VT
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Zip | 05829
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Country | US
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Telephone | 802-334-6744
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Fax |
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Provider Business Mailing Address
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Address Line | 1197 VT ROUTE 114 S
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City | NORTON
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State | VT
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Zip | 05907-9709
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Country | US
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Telephone |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 151.0126525
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License Number State | VT
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