NPI 1003247958

Gregory Henderson, LADC

Practitioner Addiction (Substance Use Disorder) Counselor Wilder, VT

Practice location

Address: 39 Fogg Farm Road, Wilder, VT 05088
Phone: (802) 295-1311
Fax: (802) 295-1312
Mailing address: 11 N Main St, Randolph, VT 05060-1126

Registered specialties

Addiction (Substance Use Disorder) Counselor Primary

Behavioral Health & Social Service Providers Taxonomy 101YA0400X Licence 00608 (VT)

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Registry record

NPI: 1003247958
Entity type: Individual
Sex (as registered): Male
NPI issued: 3 Dec 2013
Record last updated: 3 Dec 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.