Basic Information
| Provider Information | |||||||||
| NPI: | 1356890842 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOODS | ||||||||
| FirstName: | MARY | ||||||||
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| Credential: | RNC, LADC, MSHS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1361 ELM ST | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031011324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036344446 | ||||||||
| FaxNumber: | 6036344447 | ||||||||
| Practice Location | |||||||||
| Address1: | 1361 ELM ST | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031011324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036344446 | ||||||||
| FaxNumber: | 6036344447 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2016 | ||||||||
| LastUpdateDate: | 09/26/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 0046 | NH | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 163W00000X | 817395 | NH | N | Nursing Service Providers | Registered Nurse | 364SP0809X | 283983-03 | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Adult |
No ID Information.