| NPI | 1528622909 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW FOWLER Member 603-531-8811 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2019-05-01 |
| Last Update Date | 2023-06-14 |