| Mystic Horizons, Llc | |
|
4995 Silver St Hinesburg VT 05461-9487 | |
| (802) 734-5864 | |
| Not Available |
| Full Name | Mystic Horizons, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 4995 Silver St, Hinesburg, Vermont |
| Authorized Official Name and Position | Ashley Marie Mccullough (LICENSED CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 8027345864 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mystic Horizons, Llc 4995 Silver St Hinesburg VT 05461-9487 Ph: (802) 734-5864 | Mystic Horizons, Llc 4995 Silver St Hinesburg VT 05461-9487 Ph: (802) 734-5864 |
| NPI Number | 1225706195 |
|---|---|
| Provider Enumeration Date | 09/03/2021 |
| Last Update Date | 09/03/2021 |
| Certification Date | 09/03/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225706195 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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