Individual
GREGORY HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
39 FOGG FARM ROAD, WILDER, VT 05088
(802) 295-1311
(802) 295-1312
Mailing address
11 N MAIN ST, RANDOLPH, VT 05060-1126
(802) 728-4466
(802) 728-4197
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
00608
VT
Other
Enumeration date
12/03/2013
Last updated
12/03/2013
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