Provider Demographics
NPI:1043566334
Name:HOME BASE COLLABORATIVE FAMILY COUNSELING
Entity Type:Organization
Organization Name:HOME BASE COLLABORATIVE FAMILY COUNSELING
Other - Org Name:HOME BASE COLLABORATIVE FAMILY COUNSELING LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARIS
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:I
Authorized Official - Credentials:LICSW
Authorized Official - Phone:603-998-5186
Mailing Address - Street 1:1850 ELM ST STE 2
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-2911
Mailing Address - Country:US
Mailing Address - Phone:603-998-5186
Mailing Address - Fax:
Practice Address - Street 1:1850 ELM ST STE 2
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-2911
Practice Address - Country:US
Practice Address - Phone:603-998-5186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty