Basic Information
| Provider Information | |||||||||
| NPI: | 1780754093 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WARREN STREET FAMILY COUNSELING ASSOC INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 33 WARREN ST | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032261999 | ||||||||
| FaxNumber: | 6032241675 | ||||||||
| Practice Location | |||||||||
| Address1: | 33 WARREN ST | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032261999 | ||||||||
| FaxNumber: | 6032241675 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FREESE | ||||||||
| AuthorizedOfficialFirstName: | C ANN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6032261999 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MA LMHC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 326417 | 01 | MHN TRICARE | OTHER |