Active NPI
Tony J Graveline, LADC
- Mental Health Counselor
- Derby, VT
National Provider Identifier
1023316494
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 0680101473
- Practice address
- 181 Crawford Road
Derby, VT 05829 - Phone
- (802) 334-6744
- NPI assigned
- Mar 8, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 0680101473 | VT | Primary |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 000526 | VT |
Addresses
Primary practice location
181 Crawford Road
Derby, VT 05829
Mailing address
PO Box 724
Newport, VT 05855
Phone (802) 334-6744
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000526 | VT | MD | Addiction (Substance Use Disorder) Counselor |
| 0680101473 | VT | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1299542400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1409875200000",
"number": "1023316494",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 724",
"city": "NEWPORT",
"state": "VT",
"postal_code": "05855",
"telephone_number": "802-334-6744"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "181 CRAWFORD ROAD",
"city": "DERBY",
"state": "VT",
"postal_code": "05829",
"telephone_number": "802-334-6744"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAVELINE",
"first_name": "TONY",
"middle_name": "J",
"credential": "LADC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-03-08",
"last_updated": "2014-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "VT",
"license": "0680101473",
"primary": true
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "VT",
"license": "000526",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Derby, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.