Individual
MR. CHANON WATTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCMHC, LADC
Contact information
Practice address
86 LAKE ST, BURLINGTON, VT 05401-5297
(802) 734-1786
Mailing address
86 LAKE ST, BURLINGTON, VT 05401-5297
(802) 734-1786
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
000588
VT
101YM0800X
Mental Health Counselor
Primary
068.0100521
VT
Other
Enumeration date
10/04/2015
Last updated
10/04/2015
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