Organization
CENTER FOR TRAUMA RECOVERY LLC
Active
Other names
Center for Trauma Recovery
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES J. CORBALLY LICSW (CO OWNER)
(802) 281-3330
Entity
Organization
Contact information
Practice address
523 SMUGGLERS VIEW RD, JEFFERSONVILLE, VT 05464-9450
(802) 324-3792
Mailing address
523 SMUGGLERS VIEW RD, JEFFERSONVILLE, VT 05464-9450
(802) 324-3792
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1028428
—
VT
Enumeration date
09/10/2021
Last updated
09/10/2021
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