Individual
MS. PAMELA ANN FORMICA I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCMHC, LADC
Contact information
Practice address
231 MAPLE ST, SUITE 1, BURLINGTON, VT 05401-4562
(802) 863-4800
(802) 862-9339
Mailing address
231 MAPLE ST, SUITE 1, BURLINGTON, VT 05401-4562
(802) 863-4800
(802) 862-9339
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
000348
VT
101YM0800X
Mental Health Counselor
Primary
0680000601
VT
Other
Enumeration date
06/23/2006
Last updated
01/06/2011
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