Provider Demographics
NPI:1891288320
Name:ACKLEY, LAURA MAY (MA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MAY
Last Name:ACKLEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 HUNTINGTON RD STE 102
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VT
Mailing Address - Zip Code:05477-9841
Mailing Address - Country:US
Mailing Address - Phone:802-858-5511
Mailing Address - Fax:
Practice Address - Street 1:65 HUNTINGTON RD STE 102
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VT
Practice Address - Zip Code:05477-9841
Practice Address - Country:US
Practice Address - Phone:802-858-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-09
Last Update Date:2018-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health