Provider Demographics
NPI:1376879585
Name:HUNTER, MICHAEL C (LCMHC, LADC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:HUNTER
Suffix:
Gender:M
Credentials:LCMHC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 BOLTON VALLEY ACCESS RD
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05676-9214
Mailing Address - Country:US
Mailing Address - Phone:802-598-5932
Mailing Address - Fax:
Practice Address - Street 1:145 PINE HAVEN SHORES RD STE 1132
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-7703
Practice Address - Country:US
Practice Address - Phone:802-598-5932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-22
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT151.0127850101YA0400X
VT068.0057145101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)