Individual
CHLOE LARA-RUSSACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
186 OLDE ORCHARD LN, SHELBURNE, VT 05482-6770
(617) 877-8130
Mailing address
186 OLDE ORCHARD LN, SHELBURNE, VT 05482-6770
(617) 877-8130
Taxonomy
Speciality
Code
Description
License number
State
101200000X
Drama Therapist
—
—
101Y00000X
Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
12/12/2022
Last updated
12/12/2022
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