Provider Demographics
NPI:1427129857
Name:WILLIAMSON, ED M (LCMHC/LADC)
Entity type:Individual
Prefix:
First Name:ED
Middle Name:M
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:LCMHC/LADC
Other - Prefix:
Other - First Name:EDWARD
Other - Middle Name:HAMMER
Other - Last Name:WILLIAMSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCMHC/LADC
Mailing Address - Street 1:208 FLYNN AVE
Mailing Address - Street 2:3-J
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5429
Mailing Address - Country:US
Mailing Address - Phone:802-488-6900
Mailing Address - Fax:802-488-6919
Practice Address - Street 1:172 FAIRFIELD ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-1743
Practice Address - Country:US
Practice Address - Phone:802-488-6265
Practice Address - Fax:802-488-6919
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000423101YM0800X
VT0001000101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1007279Medicaid