Organization
REVOLUTION YOUTH INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAVANNAH LORD LICSW, LADC (DIRECTOR OF CLINICAL SERVICES)
(207) 812-6070
Entity
Organization
Contact information
Practice address
95 COLLEGE ST, BURLINGTON, VT 05401-8426
(207) 812-6070
Mailing address
95 COLLEGE ST, BURLINGTON, VT 05401-8426
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
01/07/2022
Last updated
11/18/2024
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