Provider Demographics
NPI:1447358916
Name:LAFRENIERE, CHRISTINE V (LCMHC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:V
Last Name:LAFRENIERE
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 1:11 S MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:VERGENNES
Mailing Address - State:VT
Mailing Address - Zip Code:05491-1205
Mailing Address - Country:US
Mailing Address - Phone:802-877-6222
Mailing Address - Fax:802-877-6250
Practice Address - Street 1:11 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:VERGENNES
Practice Address - State:VT
Practice Address - Zip Code:05491-1205
Practice Address - Country:US
Practice Address - Phone:802-877-6222
Practice Address - Fax:802-877-6250
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0680000428101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1007822Medicaid