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General NPI Number Information
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NPI Number | 1811443955
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Entity Type | Organization
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Legal Business Name | THE INNER SPIRAL
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Dates
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Enumeration Date | 08/29/2016
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Last Update Date | 08/29/2016
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Provider Practice Location Address
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Address Line | 1085 US ROUTE 4 E VT EDUCATIONAL SUPPORT ASSOCIATES
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City | RUTLAND
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State | VT
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Zip | 05701-8860
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Country | US
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Telephone | 802-775-6331
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Fax |
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Provider Business Mailing Address
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Address Line | 1085 US ROUTE 4 E VT EDUCATIONAL SUPPORT ASSOCIATES
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City | RUTLAND
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State | VT
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Zip | 05701-8860
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Country | US
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Telephone | 802-775-6331
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | LISA STECKLER
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Credential | LCMHC
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Telephone | 802-775-6331
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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 | 068.0090928
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License Number State | VT
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