Provider Demographics
NPI:1811417256
Name:HALLIGAN, THOMAS J JR
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:HALLIGAN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1197 VT ROUTE 114 S
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:VT
Mailing Address - Zip Code:05907-9709
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:181 CRAWFORD ROAD
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:VT
Practice Address - Zip Code:05829
Practice Address - Country:US
Practice Address - Phone:802-334-6744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT151.0126525101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)