Provider Demographics
NPI:1497809867
Name:A FERAL WIND COUNSELING, INC.
Entity Type:Organization
Organization Name:A FERAL WIND COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUCE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:802-793-9316
Mailing Address - Street 1:28 PRIVATE ROAD 8
Mailing Address - Street 2:
Mailing Address - City:MIDDLESEX
Mailing Address - State:VT
Mailing Address - Zip Code:05602
Mailing Address - Country:US
Mailing Address - Phone:802-793-9316
Mailing Address - Fax:802-223-3885
Practice Address - Street 1:28 PRIVATE ROAD 8
Practice Address - Street 2:
Practice Address - City:MIDDLESEX
Practice Address - State:VT
Practice Address - Zip Code:05602
Practice Address - Country:US
Practice Address - Phone:802-793-9316
Practice Address - Fax:802-223-3885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048-0000694103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT68913Medicaid