Provider Demographics
NPI:1861585382
Name:SALLY EDITH PC
Entity type:Organization
Organization Name:SALLY EDITH PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LMHC
Authorized Official - Prefix:MS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:EDITH
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:803-651-7566
Mailing Address - Street 1:35 TIMBER LANE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403
Mailing Address - Country:US
Mailing Address - Phone:802-651-7566
Mailing Address - Fax:802-860-3613
Practice Address - Street 1:35 TIMBER LANE
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403
Practice Address - Country:US
Practice Address - Phone:802-651-7566
Practice Address - Fax:802-860-3613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000456101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty