Organization
NORTHWESTERN COUNSELING & SUPPORT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TED JOHN MABLE II ED.D. (EXECUTIVE DIRECTOR)
(802) 524-6555
Entity
Organization
Contact information
Practice address
107 FISHER POND ROAD, SAINT ALBANS, VT 05478-6286
(802) 524-6554
(802) 524-6562
Mailing address
107 FISHER POND ROAD, SAINT ALBANS, VT 05478-6286
(802) 524-6554
(802) 524-6562
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1006630
—
VT
01
—
2050939
CIGNA
VT
01
—
355023
MHN
VT
01
—
491116
VALUE OPTIONS
VT
05
—
6030001
—
VT
05
—
6040012
—
VT
01
—
66316
MVP
VT
01
—
CN7031
RR MEDICARE
VT
01
—
FRAN6103
BCBS
VT
Enumeration date
03/19/2007
Last updated
11/18/2013
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