Provider Demographics
NPI:1811443955
Name:THE INNER SPIRAL
Entity type:Organization
Organization Name:THE INNER SPIRAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:STECKLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:802-775-6331
Mailing Address - Street 1:1085 US ROUTE 4 E
Mailing Address - Street 2:VT EDUCATIONAL SUPPORT ASSOCIATES
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-8860
Mailing Address - Country:US
Mailing Address - Phone:802-775-6331
Mailing Address - Fax:
Practice Address - Street 1:1085 US ROUTE 4 E
Practice Address - Street 2:VT EDUCATIONAL SUPPORT ASSOCIATES
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-8860
Practice Address - Country:US
Practice Address - Phone:802-775-6331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0090928101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty