Provider Demographics
NPI:1386763225
Name:SYNERGY COUNSELING GROUP, LLC
Entity type:Organization
Organization Name:SYNERGY COUNSELING GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HAMEL
Authorized Official - Suffix:
Authorized Official - Credentials:LADC, CADC
Authorized Official - Phone:802-225-5924
Mailing Address - Street 1:2 CLOVER LN
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:VT
Mailing Address - Zip Code:05465-3129
Mailing Address - Country:US
Mailing Address - Phone:802-225-5924
Mailing Address - Fax:802-858-0027
Practice Address - Street 1:2 CLOVER LN
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:VT
Practice Address - Zip Code:05465-3129
Practice Address - Country:US
Practice Address - Phone:802-225-5924
Practice Address - Fax:802-858-0027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000099261QR0405X
VT261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Not Answered261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health