Healthcare Provider Details

I. General information

NPI: 1588994594
Provider Name (Legal Business Name): ROBERT WILFRED DUMOND LCMHC, CCMHC, DIPCFC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2010
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 W SHORE RD
BRISTOL NH
03222-3731
US

IV. Provider business mailing address

61 W SHORE RD
BRISTOL NH
03222-3731
US

V. Phone/Fax

Practice location:
  • Phone: 603-438-6767
  • Fax:
Mailing address:
  • Phone: 603-438-6767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1090
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number#117
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: