Provider Demographics
NPI:1972809101
Name:LAROCQUE, ANN E (LCMHC)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:E
Last Name:LAROCQUE
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 224
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:VT
Mailing Address - Zip Code:05034-0224
Mailing Address - Country:US
Mailing Address - Phone:802-672-1891
Mailing Address - Fax:
Practice Address - Street 1:32 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:VT
Practice Address - Zip Code:05091-1122
Practice Address - Country:US
Practice Address - Phone:802-672-1891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-05
Last Update Date:2011-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0680000731101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional