Healthcare Provider Details

I. General information

NPI: 1619615390
Provider Name (Legal Business Name): ABIGAEL EASTMAN COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 SCHOOL ST
CONCORD NH
03301-3930
US

IV. Provider business mailing address

293 STARK HWY N
DUNBARTON NH
03046-4715
US

V. Phone/Fax

Practice location:
  • Phone: 603-229-7260
  • Fax:
Mailing address:
  • Phone: 603-229-7260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ABIGAEL DAVINA EASTMAN
Title or Position: THERAPIST
Credential: LCMHC
Phone: 603-229-7260