Provider Demographics
NPI:1508317462
Name:EFREMOVSKI, BLAGORODNA (LCMHC, LADC)
Entity Type:Individual
Prefix:PROF
First Name:BLAGORODNA
Middle Name:
Last Name:EFREMOVSKI
Suffix:
Gender:F
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 1:18 STEEPLEBUSH RD
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-2282
Mailing Address - Country:US
Mailing Address - Phone:802-238-4459
Mailing Address - Fax:
Practice Address - Street 1:18 STEEPLEBUSH RD
Practice Address - Street 2:
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-2282
Practice Address - Country:US
Practice Address - Phone:802-238-4459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-16
Last Update Date:2016-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT151.0124715101YA0400X
VT068.0057666101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)