Provider Demographics
NPI:1285275164
Name:STICKNEY, TORY E (LADC, LCMHC, PMH-C)
Entity type:Individual
Prefix:
First Name:TORY
Middle Name:E
Last Name:STICKNEY
Suffix:
Gender:F
Credentials:LADC, LCMHC, PMH-C
Other - Prefix:
Other - First Name:TORY
Other - Middle Name:
Other - Last Name:OWENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 539
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:VT
Mailing Address - Zip Code:05468-0539
Mailing Address - Country:US
Mailing Address - Phone:802-318-6443
Mailing Address - Fax:
Practice Address - Street 1:151 WOODCREST CIR
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:VT
Practice Address - Zip Code:05468-3708
Practice Address - Country:US
Practice Address - Phone:802-318-6443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT151-0134079101YA0400X
VT068.0134297101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT6706333Medicaid