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Organization

XANDER LODGE, MA, PLC

Active
Other names
LODGE PSYCHOTHERAPY
Organization subpart
No

Provider details

NPI number
Authorized official
ALEXANDER LODGE MA (OWNER)
(802) 503-2929
Entity
Organization

Contact information

Practice address
75 TALCOTT RD STE 30, WILLISTON, VT 05495-8122
(802) 503-2929
Mailing address
629 METCALF DR, WILLISTON, VT 05495-8802
(802) 503-2929

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary

Other

Enumeration date
09/19/2022
Last updated
06/17/2024
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