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Organization
INSTITUTE OF TRAUMA RECOVERY AND RESILIENCY
Active
Organization
INSTITUTE OF TRAUMA RECOVERY AND RESILIENCY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES JOSEPH CORBALLY LICSW (CO DIRECTOR)
(802) 281-3330
Entity
Organization
Contact information
Practice address
162 HEGEMAN AVE, COLCHESTER, VT 05446-3109
(802) 281-3330
Mailing address
523 SMUGGLERS VIEW RD, JEFFERSONVILLE, VT 05464-9450
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
NULL
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
NULL
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1028428
—
VT
Enumeration date
09/05/2021
Last updated
09/05/2021
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