Healthcare Provider Details

I. General information

NPI: 1871161455
Provider Name (Legal Business Name): FRUITION COUNSELING & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 06/11/2021
Certification Date: 06/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

472 HIGH ST STE 303
SOMERSWORTH NH
03878-1012
US

IV. Provider business mailing address

472 HIGH ST STE 303
SOMERSWORTH NH
03878-1012
US

V. Phone/Fax

Practice location:
  • Phone: 603-515-6549
  • Fax:
Mailing address:
  • Phone: 603-515-6549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ELISSA ELLIOTT
Title or Position: MANAGER
Credential: MS, LCMHC
Phone: 603-515-6549