Provider Demographics
NPI:1710476908
Name:LUTSCHG, ADRIENNE SELENE (LCMHC)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:SELENE
Last Name:LUTSCHG
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 1:1743 BLISS RD
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05658-8229
Mailing Address - Country:US
Mailing Address - Phone:802-371-7787
Mailing Address - Fax:
Practice Address - Street 1:105 N MAIN ST STE 209
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-3791
Practice Address - Country:US
Practice Address - Phone:802-477-2263
Practice Address - Fax:802-622-0956
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
068.0104735101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health