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Individual

TONY J GRAVELINE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LADC

Contact information

Practice address
181 CRAWFORD ROAD, DERBY, VT 05829
(802) 334-6744
Mailing address
PO BOX 724, NEWPORT, VT 05855
(802) 334-6744

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
000526
VT
101YM0800X
Mental Health Counselor
Primary
0680101473
VT

Other

Enumeration date
03/08/2011
Last updated
09/05/2014
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