Healthcare Provider Details

I. General information

NPI: 1124918834
Provider Name (Legal Business Name): MOONSHADOW COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2025
Last Update Date: 10/11/2025
Certification Date: 10/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 FIRST ST
COLEBROOK NH
03576-3128
US

IV. Provider business mailing address

25 RIDGEWOOD DR
PITTSBURG NH
03592-5219
US

V. Phone/Fax

Practice location:
  • Phone: 603-331-3604
  • Fax: 307-323-3953
Mailing address:
  • Phone: 603-331-3604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SUZAN P DEWITT
Title or Position: OWNER/PROVIDER
Credential:
Phone: 603-237-5862