Provider Demographics
NPI:1134381866
Name:SARGENT, ALEXIS J (LADC)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:J
Last Name:SARGENT
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:
Other - Last Name:BURROUGHS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:VT
Mailing Address - Zip Code:05060-1126
Mailing Address - Country:US
Mailing Address - Phone:802-728-4466
Mailing Address - Fax:802-728-4197
Practice Address - Street 1:11 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:VT
Practice Address - Zip Code:05060-1126
Practice Address - Country:US
Practice Address - Phone:802-728-4466
Practice Address - Fax:802-728-4197
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000428101YA0400X
VT089.00521351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)