Provider Demographics
NPI:1669136420
Name:CHAMPINE, KAYJA MARIE (MS, NCC, LCMHC)
Entity type:Individual
Prefix:
First Name:KAYJA
Middle Name:MARIE
Last Name:CHAMPINE
Suffix:
Gender:F
Credentials:MS, NCC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 CRAMTON AVE
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-2604
Mailing Address - Country:US
Mailing Address - Phone:860-922-6827
Mailing Address - Fax:
Practice Address - Street 1:78 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4591
Practice Address - Country:US
Practice Address - Phone:802-775-2381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health