Individual
MR. DANIEL BASLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
151.0126712
VT
1041C0700X
Clinical Social Worker
Primary
089.0090488
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1022005
—
VT
Enumeration date
11/01/2010
Last updated
03/17/2018
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