Healthcare Provider Details

I. General information

NPI: 1659998201
Provider Name (Legal Business Name): LAURA MACK MA, LADC, LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA DEWEY MA, LADC, LCMHC

II. Dates (important events)

Enumeration Date: 06/30/2020
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 SWIFTWATER RD
WOODSVILLE NH
03785-1447
US

IV. Provider business mailing address

25 MOUNT EUSTIS RD
LITTLETON NH
03561-3712
US

V. Phone/Fax

Practice location:
  • Phone: 603-747-3740
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number151.0129414
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0132901
License Number StateVT
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2666
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: