Healthcare Provider Details

I. General information

NPI: 1629502620
Provider Name (Legal Business Name): CAROL HOUGHTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2017
Last Update Date: 08/04/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2957 MAIN STREET
BETHLEHEM NH
03574-0357
US

IV. Provider business mailing address

29 MAPLE ST
LITTLETON NH
03561-4729
US

V. Phone/Fax

Practice location:
  • Phone: 603-617-4815
  • Fax:
Mailing address:
  • Phone: 603-444-5358
  • Fax: 603-444-0145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0817
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1166
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: