Healthcare Provider Details

I. General information

NPI: 1508238783
Provider Name (Legal Business Name): SAFE SURROUNDINGS NE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2015
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 CENTER ST SUITE 19
WOLFEBORO NH
03894-4324
US

IV. Provider business mailing address

PO BOX 1464
WOLFEBORO NH
03894-1464
US

V. Phone/Fax

Practice location:
  • Phone: 603-569-5818
  • Fax:
Mailing address:
  • Phone: 603-569-5818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0816
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1529
License Number StateNH

VIII. Authorized Official

Name: MELISSA FERNALD
Title or Position: OWNER
Credential: MLADC, LICSW
Phone: 603-569-5818