Healthcare Provider Details

I. General information

NPI: 1679814040
Provider Name (Legal Business Name): MR. JAMES STODDARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2013
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 W MAIN ST
CONWAY NH
03818-6142
US

IV. Provider business mailing address

87 WASHINGTON ST
CONWAY NH
03818-6044
US

V. Phone/Fax

Practice location:
  • Phone: 603-447-2111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1176
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1014
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: