Healthcare Provider Details

I. General information

NPI: 1831617125
Provider Name (Legal Business Name): CAROL LYN GAY M.A., LCMHC, MLADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 COMMERCIAL ST STE 3004
MANCHESTER NH
03101-1118
US

IV. Provider business mailing address

17 TENNEY RD
GOFFSTOWN NH
03045-3104
US

V. Phone/Fax

Practice location:
  • Phone: 603-668-3050
  • Fax: 603-668-8666
Mailing address:
  • Phone: 603-953-3069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1037
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number801
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: