Healthcare Provider Details

I. General information

NPI: 1245305671
Provider Name (Legal Business Name): MARK S LINETT LACD LCMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 NORTH ST RECOVERY CTR COUNSELING CTR
CLAREMONT NH
03743
US

IV. Provider business mailing address

9 HANOVER ST SUITE 2 WEST CENTRAL SERVICES INC
LEBANON NH
03766
US

V. Phone/Fax

Practice location:
  • Phone: 603-542-2578
  • Fax: 603-542-5456
Mailing address:
  • Phone: 603-448-0126
  • Fax: 603-448-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number163
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number251
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: