MEDICARE: MR. DUANE D DREW LADC, LCMHC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	1045	NH
2	101YM0800X	Mental Health Counselor	2460	NH

General Provider Information

NPI Number	:	1922722735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DUANE D DREW LADC, LCMHC

Provider Business Mailing Address
First Line	:	27 PRESCOTT ST APT 7
Second Line	:
City	:	CONCORD
State	:	NH
Zip	:	03301-6163
Country	:	US
Telephone Number	:	603-731-4448
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 S STATE ST
Second Line	:
City	:	CONCORD
State	:	NH
Zip	:	03301-3528
Country	:	US
Telephone Number	:	603-237-1284
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2022
Last Update Date	:	12/30/2022

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