Organization
GREEN MOUNTAIN COUNSELING ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THEODORE E WALLS LCMHC (OWNER)
(413) 345-8745
Entity
Organization
Contact information
Practice address
167 MAIN ST, SUITE 207-D, BRATTLEBORO, VT 05301-7128
(413) 345-8745
(877) 532-0268
Mailing address
167 MAIN ST, SUITE 207-D, BRATTLEBORO, VT 05301-7128
(413) 345-8745
(877) 532-0268
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
068.0067951
VT
1041C0700X
Clinical Social Worker
089.0000688
VT
Other
Enumeration date
05/17/2016
Last updated
09/29/2016
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