Provider Demographics
NPI:1023536737
Name:GOULD, JOANNA (LADC,LCMHC)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:GOULD
Suffix:
Gender:F
Credentials:LADC,LCMHC
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:
Other - Last Name:WOJTOWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:208 FLYNN AVE STE 3J
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5420
Mailing Address - Country:US
Mailing Address - Phone:802-488-6920
Mailing Address - Fax:802-488-6919
Practice Address - Street 1:75 SAN REMO DR
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6385
Practice Address - Country:US
Practice Address - Phone:802-488-7350
Practice Address - Fax:802-488-6919
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT151-0132461101YA0400X
VT068-0100839101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)