Organization
NORTHWESTERN COUNSELING & SUPPORT SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TED JOHN MABLE ED.D. (EXECUTIVE DIRECTOR)
(802) 524-6555
Entity
Organization
Contact information
Practice address
107 FISHER POND RD, SAINT ALBANS, VT 05478-6286
(802) 524-6554
(802) 524-6562
Mailing address
107 FISHER POND RD, SAINT ALBANS, VT 05478-6286
(802) 524-6554
(802) 524-6562
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251K00000X
Public Health or Welfare Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261Q00000X
Clinic/Center
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
310400000X
Assisted Living Facility
—
—
315P00000X
Intellectual Disabilities Intermediate Care Facility
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006103
—
VT
05
—
1001094
—
VT
05
—
1006107
—
VT
05
—
1006428
—
VT
05
—
1006629
—
VT
05
—
1007307
—
VT
05
—
1009766
—
VT
05
—
1009767
—
VT
01
—
2050939
CIGNA
VT
01
—
355023
MHN
VT
01
—
491116
VALUE OPTIONS
VT
01
—
66316
MVP
VT
01
—
CN7031
RR MEDICARE
VT
01
—
FRAN6103
BCBS
VT
Enumeration date
10/12/2006
Last updated
09/10/2015
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