Provider Demographics
NPI:1235684101
Name:COMPLETE CIRCLE COUNSELING
Entity type:Organization
Organization Name:COMPLETE CIRCLE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALCOHOL AND DRUG COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, ADC
Authorized Official - Phone:802-748-5364
Mailing Address - Street 1:231 CONCORD AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-1513
Mailing Address - Country:US
Mailing Address - Phone:802-748-5364
Mailing Address - Fax:
Practice Address - Street 1:231 CONCORD AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-1513
Practice Address - Country:US
Practice Address - Phone:802-748-5364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT104440302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization