Provider Demographics
NPI:1649931874
Name:SPROUT SUPPORTIVE COUNSELING LLC
Entity type:Organization
Organization Name:SPROUT SUPPORTIVE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:GIUMARRA
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:802-391-9514
Mailing Address - Street 1:PO BOX 101
Mailing Address - Street 2:
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404-0101
Mailing Address - Country:US
Mailing Address - Phone:802-391-9514
Mailing Address - Fax:
Practice Address - Street 1:337 COLLEGE ST STE 302
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8344
Practice Address - Country:US
Practice Address - Phone:802-391-9514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health