Provider Demographics
NPI:1962952457
Name:RED CLOVER COUNSELING, LLC
Entity type:Organization
Organization Name:RED CLOVER COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:CASTONGUAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:207-478-5446
Mailing Address - Street 1:6 MERRILL LN UNIT 103
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:VT
Mailing Address - Zip Code:05468-3324
Mailing Address - Country:US
Mailing Address - Phone:207-478-5446
Mailing Address - Fax:
Practice Address - Street 1:6 MERRILL LN UNIT 103
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:VT
Practice Address - Zip Code:05468-3324
Practice Address - Country:US
Practice Address - Phone:207-478-5446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0057801101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1019925Medicaid