Provider Demographics
NPI:1700244100
Name:ALVIN, JENNELLE (MS LCMHC LADC NCC)
Entity Type:Individual
Prefix:
First Name:JENNELLE
Middle Name:
Last Name:ALVIN
Suffix:
Gender:F
Credentials:MS LCMHC LADC NCC
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 1075
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05601-1075
Mailing Address - Country:US
Mailing Address - Phone:802-345-5630
Mailing Address - Fax:
Practice Address - Street 1:133 ELM ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-3233
Practice Address - Country:US
Practice Address - Phone:802-552-8622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000700101YA0400X
VT068.0117881101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)