| Kingdom Therapeutics At Safe Haven Farm, Incorporated | |
|
4095 Gore Rd Derby VT 05829-9408 | |
| (802) 673-6476 | |
| Not Available |
| Full Name | Kingdom Therapeutics At Safe Haven Farm, Incorporated |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 4095 Gore Rd, Derby, Vermont |
| Authorized Official Name and Position | Kristen Watson (CLINICAL MENTAL HEALTH COUNSELOR) |
| Authorized Official Contact | 8026736476 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kingdom Therapeutics At Safe Haven Farm, Incorporated 2735 Dane Hill Rd West Charleston VT 05872-9581 Ph: (802) 673-6476 | Kingdom Therapeutics At Safe Haven Farm, Incorporated 4095 Gore Rd Derby VT 05829-9408 Ph: (802) 673-6476 |
| NPI Number | 1609462605 |
|---|---|
| Provider Enumeration Date | 12/15/2020 |
| Last Update Date | 12/15/2020 |
| Certification Date | 12/15/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609462605 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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