Provider Demographics
NPI:1609482215
Name:WALLINGFORD, ANN (MS, LCMHC)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:WALLINGFORD
Suffix:
Gender:F
Credentials:MS, LCMHC
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:MELIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LCMHC
Mailing Address - Street 1:4579 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:E MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05651-4261
Mailing Address - Country:US
Mailing Address - Phone:802-595-5065
Mailing Address - Fax:
Practice Address - Street 1:4579 CENTER RD
Practice Address - Street 2:
Practice Address - City:E MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05651-4261
Practice Address - Country:US
Practice Address - Phone:802-595-5065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0134258101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT6704898Medicaid