Healthcare Provider Details

I. General information

NPI: 1144246612
Provider Name (Legal Business Name): UNION MENTAL HEALTH & PASTORAL COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 STATE ROUTE 101A
AMHERST NH
03031-2290
US

IV. Provider business mailing address

89 STATE ROUTE 101A
AMHERST NH
03031-2290
US

V. Phone/Fax

Practice location:
  • Phone: 603-673-6643
  • Fax: 603-673-6620
Mailing address:
  • Phone: 603-673-6643
  • Fax: 603-673-6620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number91
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberLLP#8
License Number StateNH

VIII. Authorized Official

Name: MRS. DAWN BIGELOW FORMICA
Title or Position: MEMBER
Credential: M.A.
Phone: 603-673-6643