# INSTITUTE OF TRAUMA RECOVERY AND RESILIENCY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093483851
- **Authorized official:** CHARLES JOSEPH CORBALLY LICSW (CO DIRECTOR)
- **Authorized official phone:** (802) 281-3330

## Contact information

- **Practice address:** 162 HEGEMAN AVE, COLCHESTER, VT 05446-3109
- **Practice address phone:** (802) 281-3330
- **Mailing address:** 523 SMUGGLERS VIEW RD, JEFFERSONVILLE, VT 05464-9450

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 09/05/2021
- **Last updated:** 09/05/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1028428 | — | VT |