Provider Demographics
NPI:1275254518
Name:EASON, ANDRE JERMAINE JR (LADC, LCMHC)
Entity Type:Individual
Prefix:MR
First Name:ANDRE
Middle Name:JERMAINE
Last Name:EASON
Suffix:JR
Gender:M
Credentials:LADC, LCMHC
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 62
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:VT
Mailing Address - Zip Code:05837-0062
Mailing Address - Country:US
Mailing Address - Phone:203-721-2931
Mailing Address - Fax:
Practice Address - Street 1:2225 PORTLAND ST
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-8635
Practice Address - Country:US
Practice Address - Phone:802-334-6744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0135630101YM0800X
VT151.0134147101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health