Healthcare Provider Details

I. General information

NPI: 1295223857
Provider Name (Legal Business Name): ANGELA LYNN WHITING LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2018
Last Update Date: 06/16/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 LAKE AVENUE FARNUM CENTER OUT PATIENT
MANCHESTER NH
03103
US

IV. Provider business mailing address

700 LAKE AVENUE FARNUM CENTER OUT PATIENT
MANCHESTER NH
03103
US

V. Phone/Fax

Practice location:
  • Phone: 603-622-3020
  • Fax: 603-622-4043
Mailing address:
  • Phone: 603-622-3020
  • Fax: 603-622-4043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLADC1521
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: