Healthcare Provider Details

I. General information

NPI: 1548189582
Provider Name (Legal Business Name): CHARLENE EVETTE LEADER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 W BROADWAY
DERRY NH
03038-2375
US

IV. Provider business mailing address

131 DANIEL WEBSTER HWY # 140
NASHUA NH
03060-5224
US

V. Phone/Fax

Practice location:
  • Phone: 855-930-6122
  • Fax:
Mailing address:
  • Phone: 321-609-1135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: