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General NPI Number Information
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NPI Number | 1750768420
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Entity Type | Organization
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Legal Business Name | THE VILLAGE COUNSEL, PLLC
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Dates
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Enumeration Date | 05/01/2015
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Last Update Date | 05/01/2015
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Provider Practice Location Address
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Address Line | 130 CENTRAL AVE UNIT #203
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City | DOVER
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State | NH
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Zip | 03820-4042
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Country | US
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Telephone | 603-512-1218
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Fax |
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Provider Business Mailing Address
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Address Line | 130 CENTRAL AVE UNIT #203
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City | DOVER
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State | NH
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Zip | 03820-4042
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Country | US
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Telephone | 603-512-1218
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. ELIZABETH DOPPLER-BOURASSA
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Credential | PH.D.
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Telephone | 603-512-1218
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1152
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License Number State | NH
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