Provider Demographics
NPI:1073535290
Name:HUCKINS, DAVID M (LICSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:HUCKINS
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3621
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03302-3621
Mailing Address - Country:US
Mailing Address - Phone:603-226-4446
Mailing Address - Fax:603-226-4166
Practice Address - Street 1:6D HILLS AVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4803
Practice Address - Country:US
Practice Address - Phone:603-226-4446
Practice Address - Fax:603-226-4166
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH145101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30424286Medicaid
NH30424286Medicaid