Provider Demographics
NPI:1124918834
Name:MOONSHADOW COUNSELING, LLC
Entity type:Organization
Organization Name:MOONSHADOW COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:SUZAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEWITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-331-3604
Mailing Address - Street 1:25 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:NH
Mailing Address - Zip Code:03592-5219
Mailing Address - Country:US
Mailing Address - Phone:603-331-3604
Mailing Address - Fax:
Practice Address - Street 1:25 RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:NH
Practice Address - Zip Code:03592-5219
Practice Address - Country:US
Practice Address - Phone:603-331-3604
Practice Address - Fax:603-331-3604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-04
Last Update Date:2025-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)