Healthcare Provider Details

I. General information

NPI: 1477787190
Provider Name (Legal Business Name): MARIA ALEXANDROVNA COY MS, LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2009
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 MAIN ST
NEW LONDON NH
03257-7835
US

IV. Provider business mailing address

541 MAIN ST
NEW LONDON NH
03257-7835
US

V. Phone/Fax

Practice location:
  • Phone: 603-625-0010
  • Fax: 603-625-0075
Mailing address:
  • Phone: 603-625-0010
  • Fax: 603-625-0075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number754
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: