Provider Demographics
NPI:1386099059
Name:RIVERBEND COUNSELING SERVICES, PLLC
Entity type:Organization
Organization Name:RIVERBEND COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WALDRON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCMHC, LADC, NCC
Authorized Official - Phone:802-745-9567
Mailing Address - Street 1:105 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:VT
Mailing Address - Zip Code:05867-9731
Mailing Address - Country:US
Mailing Address - Phone:802-745-9567
Mailing Address - Fax:802-467-8621
Practice Address - Street 1:231 CONCORD AVE
Practice Address - Street 2:STE 2
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-1513
Practice Address - Country:US
Practice Address - Phone:802-745-9567
Practice Address - Fax:802-467-8621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000644101YA0400X
VT068.0069442101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty