Most Relevant Information
Provider Data
| NPI Number: | 1003247958 |
| Provider Name: | GREGORY HENDERSON LADC |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: | 00608 |
Most Important Dates
| Enumeration Date: | 12/03/2013 |
| Last Updated: | 12/03/2013 |
Provider Practice Location
39 FOGG FARM ROAD
WILDER
VT
05088
Practice Location Phone/Fax
| Phone: | 8022951311 |
| Fax: | 8022951312 |
Provider Mailing Location
11 N MAIN ST
RANDOLPH
VT
050601126
Provider Mailing Phone/Fax
| Phone: | 8027284466 |
| Fax: | 8027284197 |