Provider Demographics
NPI:1336278985
Name:COUNSELING SERVICE OF ADDISON COUNTY, INC
Entity Type:Organization
Organization Name:COUNSELING SERVICE OF ADDISON COUNTY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:VANDEWEERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-388-6751
Mailing Address - Street 1:89 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-1459
Mailing Address - Country:US
Mailing Address - Phone:802-388-6751
Mailing Address - Fax:802-388-8183
Practice Address - Street 1:89 MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-1459
Practice Address - Country:US
Practice Address - Phone:802-388-6751
Practice Address - Fax:802-388-8183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0004324Medicaid
VT1009765Medicaid