Individual
MR. PHILIP LIGHTBEAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA LADC CADC
Contact information
Practice address
108 CHERRY STREET SUITE 1, ST JOHNSBURG, VT 05819
(802) 748-8842
(802) 748-9014
Mailing address
108 CHERRY STREET SUITE 1, ST JOHNSBURG, VT 05819
(802) 748-8842
(802) 748-9014
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
000420
VT
Other
Enumeration date
04/29/2008
Last updated
04/29/2008
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