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Organization

A FERAL WIND COUNSELING, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. RAVEN BRUCE PSY.D. (PRESIDENT)
(802) 793-9316
Entity
Organization

Contact information

Practice address
28 PRIVATE ROAD 8, MIDDLESEX, VT 05602
(802) 793-9316
(802) 223-3885
Mailing address
28 PRIVATE ROAD 8, MIDDLESEX, VT 05602
(802) 793-9316
(802) 223-3885

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
048-0000694
VT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
68913
VT
Enumeration date
01/23/2007
Last updated
08/22/2020
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