Healthcare Provider Details

I. General information

NPI: 1497091540
Provider Name (Legal Business Name): ANNE CONNIE OWEN MA, MLADC, LCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CONNIE ANNE OWEN MA, MLADC, LCS

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 HANOVER ST. CFS ASAT
MANCHESTER NH
03105
US

IV. Provider business mailing address

99 HANOVER ST. CFS ASAT
MANCHESTER NH
03105
US

V. Phone/Fax

Practice location:
  • Phone: 603-518-4000
  • Fax: 603-668-6260
Mailing address:
  • Phone: 603-518-4000
  • Fax: 603-668-6260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0021
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number0413
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: