Healthcare Provider Details

I. General information

NPI: 1417627936
Provider Name (Legal Business Name): CLEAR REFLECTION COUNSELING ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 PUTNAM HILL RD
LYNDEBOROUGH NH
03082-6133
US

IV. Provider business mailing address

81 PUTNAM HILL RD
LYNDEBOROUGH NH
03082-6133
US

V. Phone/Fax

Practice location:
  • Phone: 603-316-0559
  • Fax:
Mailing address:
  • Phone: 603-316-0559
  • Fax:

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 TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA LEE
Title or Position: MEMBER
Credential: MLADC
Phone: 603-484-0471