Organization
WILDFLOWER THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JACQUELINE SHEA GOODALL LICSW (OWNER/CLINICIAN)
(978) 831-3196
Entity
Organization
Contact information
Practice address
57 S MAIN ST, WATERBURY, VT 05676-1557
(978) 831-3196
Mailing address
67 FAIRGROUND RD, WATERBURY, VT 05676-8903
(978) 831-3196
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
05/28/2024
Last updated
06/24/2024
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