Organization
EARTH&LIGHT, LLC
Active
Other names
Lisa Marie Mallory Petersen
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA PETERSEN LCMHC (OWNER)
(180) 287-1082
Entity
Organization
Contact information
Practice address
8031 WILLISTON RD STE 9, WILLISTON, VT 05495-6200
(802) 858-5290
Mailing address
8031 WILLISTON RD STE 9, WILLISTON, VT 05495-6200
(802) 858-5290
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
02/29/2024
Last updated
02/29/2024
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