Individual
AMANDA M REGIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
437 S MAIN ST, BRADFORD, VT 05033-9196
(802) 222-9317
(802) 222-4818
Mailing address
PO BOX 318, BRADFORD, VT 05033-0318
(802) 222-9317
(802) 222-4818
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
151.0134039
VT
1041C0700X
Clinical Social Worker
Primary
089.0110736
VT
Other
Enumeration date
10/17/2018
Last updated
10/17/2018
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