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General NPI Number Information
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NPI Number | 1528696945
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Entity Type | Individual
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Provider Name | CHARLES QUALTERS SEXTON-DIRANIAN LADC II
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Gender | Male
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Dates
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Enumeration Date | 03/31/2020
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Last Update Date | 03/31/2020
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Provider Practice Location Address
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Address Line | 491 AMHERST ST STE 105
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City | NASHUA
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State | NH
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Zip | 03063-1259
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Country | US
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Telephone | 603-965-2567
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Fax |
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Provider Business Mailing Address
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Address Line | 8 SOUTH ST
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City | TOWNSEND
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State | MA
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Zip | 01469-1302
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Country | US
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Telephone | 978-868-8016
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 14340
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1101
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License Number State | NH
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