Healthcare Provider Details

I. General information

NPI: 1407266828
Provider Name (Legal Business Name): HEADREST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 04/12/2024
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 CHURCH ST
LEBANON NH
03766
US

IV. Provider business mailing address

141 MASCOMA ST
LEBANON NH
03766-2647
US

V. Phone/Fax

Practice location:
  • Phone: 603-448-4872
  • Fax: 603-448-1829
Mailing address:
  • Phone: 603-448-4872
  • Fax: 603-727-9353

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 Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: ERIC HARBECK JR.
Title or Position: CLINICAL DIRECTOR
Credential: MSW, LCSW, MLADC
Phone: 603-448-4872