Provider Demographics
NPI:1952124471
Name:RAWLS, ALAN THOMAS (LCMHC)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:THOMAS
Last Name:RAWLS
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 MT PHILO RD
Mailing Address - Street 2:
Mailing Address - City:NORTH FERRISBURGH
Mailing Address - State:VT
Mailing Address - Zip Code:05473-4016
Mailing Address - Country:US
Mailing Address - Phone:802-734-2900
Mailing Address - Fax:
Practice Address - Street 1:145 PINE HAVEN SHORES RD STE 1062
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-7812
Practice Address - Country:US
Practice Address - Phone:802-539-2059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0680136192101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health