Provider Demographics
NPI:1679397699
Name:EDMONDSON COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:EDMONDSON COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LCMHC
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:EDMONDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:802-522-9211
Mailing Address - Street 1:28 RIDGEWOOD TER
Mailing Address - Street 2:
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-9738
Mailing Address - Country:US
Mailing Address - Phone:802-522-9211
Mailing Address - Fax:
Practice Address - Street 1:149 STATE ST UNIT 6
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-2965
Practice Address - Country:US
Practice Address - Phone:802-522-8298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-15
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)