Individual
ELVIS LACOSTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
135 GRANGER ST, RUTLAND, VT 05701-4405
(802) 747-3588
(802) 747-7699
Mailing address
78 S MAIN ST, RUTLAND, VT 05701-4591
(802) 775-8224
(802) 747-7699
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1510127405
VT
Other
Enumeration date
08/07/2017
Last updated
08/07/2017
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