Provider Demographics
NPI:1770500613
Name:KITCHEL, ALICE S (ATR-BC, LCMHC)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:S
Last Name:KITCHEL
Suffix:
Gender:F
Credentials:ATR-BC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1194 MAIN ST
Mailing Address - Street 2:P O BOX 4224
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-2773
Mailing Address - Country:US
Mailing Address - Phone:802-748-5029
Mailing Address - Fax:802-748-5029
Practice Address - Street 1:1194 MAIN ST
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-2773
Practice Address - Country:US
Practice Address - Phone:802-748-5029
Practice Address - Fax:802-748-5029
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000133101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT88-110OtherART THERAPY REGISTRATION
VT068-0000133OtherLICENSED MENTAL HEALTH CO
VT1008285Medicaid