MEDICARE: ACADIA COUNSELING PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	955	NH

General Provider Information

NPI Number	:	1124233614
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACADIA COUNSELING PLLC

Provider Business Mailing Address
First Line	:	PO BOX 844
Second Line	:	ONE CHALET DR., STE. 106
City	:	WILTON
State	:	NH
Zip	:	03086-0844
Country	:	US
Telephone Number	:	603-654-2181
Fax Number	:	603-654-2182

Provider Business Practice Location Address
First Line	:	ONE CHALET DR., STE. 106
Second Line	:	THE SUMMIT EXECUTIVE OFFICES
City	:	WILTON
State	:	NH
Zip	:	03086-0844
Country	:	US
Telephone Number	:	603-654-2181
Fax Number	:	603-654-2182

Authorized Official
Title or Position	:	PSYCHOLOGIST OWNER
Name	:	DR. SUE H KIM
Credential	:	PH.D.
Telephone Number	:	603-654-2181

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	08/22/2020

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