Provider Demographics
NPI:1003604471
Name:RUSSELL, LYDIA SLOCUM (LCMHC)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:SLOCUM
Last Name:RUSSELL
Suffix:
Gender:
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 FOSTER HILL RD
Mailing Address - Street 2:
Mailing Address - City:EAST CALAIS
Mailing Address - State:VT
Mailing Address - Zip Code:05650-8009
Mailing Address - Country:US
Mailing Address - Phone:802-456-1098
Mailing Address - Fax:
Practice Address - Street 1:132 MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-3226
Practice Address - Country:US
Practice Address - Phone:802-461-8269
Practice Address - Fax:802-461-8269
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0136566101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health