Healthcare Provider Details

I. General information

NPI: 1952402851
Provider Name (Legal Business Name): CLARISSE A CHARLAND M.ED., MLADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 03/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 MAPLE ST SUITE 2
HOPKINTON NH
03229-3377
US

IV. Provider business mailing address

633 MAPLE ST SUITE 2
HOPKINTON NH
03229-3377
US

V. Phone/Fax

Practice location:
  • Phone: 603-863-8956
  • Fax:
Mailing address:
  • Phone: 603-863-8956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number492
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: