Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 000144 | VT |
NPI | 1013034826 |
---|---|
Provider Name | Dr. Dennis Keith Leisenring |
First Address | Stowe, VT 05672-4535 |
Second Address | Stowe, VT 05672-4248 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2007 |
Last Update Date | 08/07/2007 |