| Doctor Name: | MR. CHARLES SCOTT EARISMAN |
| NPI Number: | 1093886491 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MA |
| License Number: | |
| Business Practice Address: | 28 Park Avenue Suite 110 Williston, VT - 05495 |
| Business Phone Number: | 8028780550 |
| Business Fax Number: | 8028780440 |
| Mailing Address: | 28 Park Avenue, Suite 110 WILLISTON |
| State: | VT |
| Postal Code: | 05495 |
| Phone Number: | 8028780550 |
| Fax Number: | 8028780440 |
| NPI Enumeration Date: | 11/10/2006 |
| NPI Last Update Date: | 12/16/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |