Individual
AMBER BANTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCMHC
Contact information
Practice address
125 SAINT PAUL ST STE 106, BURLINGTON, VT 05401-8686
(802) 276-1030
Mailing address
105 DEPOT ST UNIT 1034, STOWE, VT 05672-7442
(802) 276-1030
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
068.0134865
VT
Other
Enumeration date
11/04/2022
Last updated
09/25/2023
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