Basic Information
Provider Information | |||||||||
NPI: | 1942502349 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ROSSEY | ||||||||
FirstName: | CHRISTOPHER | ||||||||
MiddleName: | DAVID | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | LADC LCMHC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1468 | ||||||||
Address2: |   | ||||||||
City: | MONTPELIER | ||||||||
State: | VT | ||||||||
PostalCode: | 056011468 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8022234156 | ||||||||
FaxNumber: | 8022234332 | ||||||||
Practice Location | |||||||||
Address1: | 100 HOSPITALITY DRIVE | ||||||||
Address2: |   | ||||||||
City: | BERLIN | ||||||||
State: | VT | ||||||||
PostalCode: | 05641 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8022234156 | ||||||||
FaxNumber: | 8022234332 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/17/2010 | ||||||||
LastUpdateDate: | 04/04/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 884 | NH | N |   | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YA0400X | 151.0124425 | VT | N |   | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 777 | NH | N |   | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | 068.0115899 | VT | Y |   | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
ID | Type | State | Issuer | Description | 3074628 | 05 | NH |   | MEDICAID |