Provider Demographics
NPI:1205350212
Name:BURKHOLDER, KATIE M (LCMHC, LADC)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:M
Last Name:BURKHOLDER
Suffix:
Gender:F
Credentials:LCMHC, LADC
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 647
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05601-0647
Mailing Address - Country:US
Mailing Address - Phone:802-229-1399
Mailing Address - Fax:802-223-8623
Practice Address - Street 1:73 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-2932
Practice Address - Country:US
Practice Address - Phone:802-225-8355
Practice Address - Fax:802-223-8105
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT151.0129230101YA0400X
101YA0400X
VT068.0134158101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)