Individual
ALEXANDER LODGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
75 TALCOTT RD STE 30, WILLISTON, VT 05495-8122
(802) 503-2929
Mailing address
629 METCALF DR, WILLISTON, VT 05495-8802
(802) 503-2929
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
047.0133699
VT
103T00000X
Psychologist
Primary
047.0133699
VT
Other
Enumeration date
09/19/2022
Last updated
01/29/2024
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