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General NPI Number Information
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NPI Number | 1124918834
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Entity Type | Organization
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Legal Business Name | MOONSHADOW COUNSELING
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Dates
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Enumeration Date | 07/04/2025
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Last Update Date | 10/11/2025
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Provider Practice Location Address
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Address Line | 6 FIRST ST
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City | COLEBROOK
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State | NH
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Zip | 03576-3128
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Country | US
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Telephone | 603-331-3604
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Fax | 307-323-3953
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Provider Business Mailing Address
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Address Line | 25 RIDGEWOOD DR
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City | PITTSBURG
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State | NH
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Zip | 03592-5219
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Country | US
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Telephone | 603-331-3604
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | SUZAN P DEWITT
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Credential |
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Telephone | 603-237-5862
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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