Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 000610 | VT |
NPI | 1003232349 |
---|---|
Provider Name | Sunnie Lobdell |
First Address | Burlington, VT 05401-4347 |
Second Address | Burlington, VT 05401-3704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2014 |
Last Update Date | 30/03/2015 |