Provider Demographics
NPI:1568639953
Name:EVANCIE, CLARE L (LCMHC)
Entity Type:Individual
Prefix:MS
First Name:CLARE
Middle Name:L
Last Name:EVANCIE
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 1:3143 QUAKER VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:WEYBRIDGE
Mailing Address - State:VT
Mailing Address - Zip Code:05753-8640
Mailing Address - Country:US
Mailing Address - Phone:802-545-3363
Mailing Address - Fax:
Practice Address - Street 1:5 PARK ST STE 3C
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-1169
Practice Address - Country:US
Practice Address - Phone:802-598-8073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000737101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT068-0000737OtherLICENSED MENTAL HEALTH COUNSELOR