Healthcare Provider Details

I. General information

NPI: 1245229780
Provider Name (Legal Business Name): KIMBERLY DAWN DUCHARME MLADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY DAWN DUCHARME MLADC

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 LAKE AVE
MANCHESTER NH
03103
US

IV. Provider business mailing address

20 PETER RD
MERRIMACK NH
03054-4543
US

V. Phone/Fax

Practice location:
  • Phone: 603-263-6303
  • Fax:
Mailing address:
  • Phone: 36-661-1625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0970
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: