Provider Demographics
NPI:1255577714
Name:CHADWICK, CHRISTOPHER (MS, LADC, AFC, CASAC)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:
Last Name:CHADWICK
Suffix:
Gender:M
Credentials:MS, LADC, AFC, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 GRANGER ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4405
Mailing Address - Country:US
Mailing Address - Phone:802-772-0700
Mailing Address - Fax:802-771-8009
Practice Address - Street 1:135 GRANGER ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4405
Practice Address - Country:US
Practice Address - Phone:802-772-0700
Practice Address - Fax:802-771-8009
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000447101YP2500X, 101YA0400X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1019731Medicaid