Basic Information
| Provider Information | |||||||||
| NPI: | 1871256933 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NOMADIC PSYCHOTHERAPY & WELLNESS COACHING, PLC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 170 MIDDLE RD N UNIT 1 | ||||||||
| Address2: | |||||||||
| City: | MIDDLEBURY | ||||||||
| State: | VT | ||||||||
| PostalCode: | 057538609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8027608214 | ||||||||
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| Address1: | 170 MIDDLE RD N UNIT 1 | ||||||||
| Address2: | |||||||||
| City: | MIDDLEBURY | ||||||||
| State: | VT | ||||||||
| PostalCode: | 057538609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8027608214 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2021 | ||||||||
| LastUpdateDate: | 10/15/2021 | ||||||||
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| AuthorizedOfficialLastName: | CASTONGUAY | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
| AuthorizedOfficialMiddleName: | PAUL | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER & CLINICIAN | ||||||||
| AuthorizedOfficialTelephone: | 8027608214 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MA, LCMHC, LPCC, MHC | ||||||||
| NPICertificationDate: | 10/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.