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General NPI Number Information
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NPI Number | 1073173100
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Entity Type | Organization
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Legal Business Name | SEAPORT SUPPORT
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Dates
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Enumeration Date | 06/20/2019
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Last Update Date | 06/20/2019
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Provider Practice Location Address
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Address Line | 212 ISLINGTON ST
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City | PORTSMOUTH
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State | NH
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Zip | 03801-4204
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Country | US
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Telephone | 603-387-2256
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Fax |
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Provider Business Mailing Address
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Address Line | 212 ISLINGTON ST
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City | PORTSMOUTH
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State | NH
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Zip | 03801-4204
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Country | US
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Telephone | 603-387-2256
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | ELIZABETH ANN CARMER
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Credential |
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Telephone | 603-988-1015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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