Provider Demographics
NPI:1871093104
Name:ALLI, ANDREA (LADC LCMHC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:ALLI
Suffix:
Gender:F
Credentials:LADC LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 SOUTHSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-9139
Mailing Address - Country:US
Mailing Address - Phone:857-284-6654
Mailing Address - Fax:
Practice Address - Street 1:5 BANK ST
Practice Address - Street 2:
Practice Address - City:NORTH BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05257-9102
Practice Address - Country:US
Practice Address - Phone:802-392-9979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0134198101YM0800X
VT151-0133423101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)