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General NPI Number Information
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NPI Number | 1992971691
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Entity Type | Individual
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Provider Name | RICHARD W CRANDALL MA, LADC, NCC
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Gender | Male
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Dates
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Enumeration Date | 05/02/2008
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Last Update Date | 11/24/2008
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Provider Practice Location Address
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Address Line | 9 HANOVER ST STE 2
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City | LEBANON
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State | NH
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Zip | 03766-1312
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Country | US
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Telephone | 603-448-0126
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Fax | 603-448-6001
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Provider Business Mailing Address
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Address Line | 9 HANOVER ST STE 2
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City | LEBANON
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State | NH
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Zip | 03766-1312
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Country | US
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Telephone | 603-448-0126
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Fax | 603-448-6001
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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 | 000419
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License Number State | VT
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