# MYSTIC HORIZONS, LLC

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

## Provider details

- **NPI number:** 1225706195
- **Authorized official:** ASHLEY MARIE MCCULLOUGH LICSW (LICENSED CLINICAL SOCIAL WORKER)
- **Authorized official phone:** (802) 734-5864

## Contact information

- **Practice address:** 4995 SILVER ST, HINESBURG, VT 05461-9487
- **Practice address phone:** (802) 734-5864
- **Mailing address:** 4995 SILVER ST, HINESBURG, VT 05461-9487
- **Mailing address phone:** (802) 734-5864

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 09/03/2021
- **Last updated:** 09/03/2021