Organization
COUNTER BALANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VINCENT BUCKHOLZ LICSW (OWNER)
(802) 692-0697
Entity
Organization
Contact information
Practice address
56 MAIN ST STE 212, SPRINGFIELD, VT 05156-2945
(802) 692-0697
Mailing address
56 MAIN ST STE 212, SPRINGFIELD, VT 05156-2945
(802) 692-0697
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
0890114807
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1030150
—
VT
Enumeration date
02/05/2018
Last updated
02/05/2018
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