Provider Demographics
NPI:1255585444
Name:THE ADAMS CENTER FOR MIND AND BODY, LLC
Entity type:Organization
Organization Name:THE ADAMS CENTER FOR MIND AND BODY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:NYHAGEN
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:802-859-1577
Mailing Address - Street 1:1233 SHELBURNE RD
Mailing Address - Street 2:PIERSON HOUSE D-2
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7700
Mailing Address - Country:US
Mailing Address - Phone:802-859-1577
Mailing Address - Fax:802-859-1571
Practice Address - Street 1:1233 SHELBURNE RD
Practice Address - Street 2:PIERSON HOUSE D-2
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7700
Practice Address - Country:US
Practice Address - Phone:802-859-1577
Practice Address - Fax:802-859-1571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0740000186133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty