Individual
JACQUELYN MARIE GEORGINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
16 TOWN CRIER DR, BRATTLEBORO, VT 05301-8669
(802) 258-4623
Mailing address
151 CHESTNUT ST, BRATTLEBORO, VT 05301-6580
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
150.0124815
VT
Other
Enumeration date
01/30/2018
Last updated
01/30/2018
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