Provider Demographics
NPI:1467606897
Name:ACHILLES, GEORGINA LYNN (LCMHC)
Entity Type:Individual
Prefix:
First Name:GEORGINA
Middle Name:LYNN
Last Name:ACHILLES
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 PINE HAVEN SHORES RD
Mailing Address - Street 2:SUITE 2091
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-7703
Mailing Address - Country:US
Mailing Address - Phone:802-233-5086
Mailing Address - Fax:
Practice Address - Street 1:145 PINE HAVEN SHORES RD
Practice Address - Street 2:SUITE 2091
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-7703
Practice Address - Country:US
Practice Address - Phone:802-233-5086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000760101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1467606897OtherBLUE CROSS/BLUE SHIELD OF VERMONT
VT1467606897OtherMAGELLAN BEHAVIORAL HEALTH
VT1467606897Medicaid
432712OtherTRICARE
VT989026COtherMVP HEALTHCARE