Organization
INSTITUTE OF TRAUMA RECOVERY AND RESILIENCY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES JOSEPH CORBALLY LICSW (CO DIRECTOR)
(802) 281-3330
Entity
Organization
Contact information
Practice address
162 HEGEMAN AVE, COLCHESTER, VT 05446-3109
(802) 281-3330
Mailing address
523 SMUGGLERS VIEW RD, JEFFERSONVILLE, VT 05464-9450
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1028428
—
VT
Enumeration date
09/05/2021
Last updated
09/05/2021
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