Healthcare Provider Details

I. General information

NPI: 1841256724
Provider Name (Legal Business Name): WILLOW LILITH WHITEHOUSE BRIGGS MA LCPC LSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. SUSAN ELIZABETH WHITEHOUSE NEVILLE

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 RIVER ROAD BOX318 HIRAM
HIRAM ME
04041
US

IV. Provider business mailing address

PO BOX 216 FREEDOM
FREEDOM NH
03836-0216
US

V. Phone/Fax

Practice location:
  • Phone: 207-625-3100
  • Fax:
Mailing address:
  • Phone: 603-539-8461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC824
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number80762
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: