Provider Demographics
NPI:1104284082
Name:ANDRZEJCZYK, COLIN (MS, LADC)
Entity type:Individual
Prefix:
First Name:COLIN
Middle Name:
Last Name:ANDRZEJCZYK
Suffix:
Gender:M
Credentials:MS, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHITE RIVER JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05001-7045
Mailing Address - Country:US
Mailing Address - Phone:603-477-7191
Mailing Address - Fax:
Practice Address - Street 1:279 HEMLOCK RD
Practice Address - Street 2:
Practice Address - City:LANGDON
Practice Address - State:NH
Practice Address - Zip Code:03602-8252
Practice Address - Country:US
Practice Address - Phone:603-477-7191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000512101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)