Basic Information
| Provider Information | |||||||||
| NPI: | 1588724678 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOUCETTE | ||||||||
| FirstName: | LAURIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LICSW, MLADC | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | DOUCETTE | ||||||||
| OtherFirstName: | LAURIE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | LICSW | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2 WALL ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031011518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036684111 | ||||||||
| FaxNumber: | 6036287757 | ||||||||
| Practice Location | |||||||||
| Address1: | 9 BLODGET ST | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031043502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036684111 | ||||||||
| FaxNumber: | 6036287757 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 03/24/2021 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 1054 | NH | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 1505 | NH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.