Provider Demographics
NPI:1023456142
Name:BURNS, DILLON TEACHOUT (LICSW)
Entity type:Individual
Prefix:
First Name:DILLON
Middle Name:TEACHOUT
Last Name:BURNS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:CALAIS
Mailing Address - State:VT
Mailing Address - Zip Code:05648-0009
Mailing Address - Country:US
Mailing Address - Phone:802-391-9002
Mailing Address - Fax:
Practice Address - Street 1:162 ELM ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-2896
Practice Address - Country:US
Practice Address - Phone:802-391-9002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.00935151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical