Provider Demographics
NPI:1144246612
Name:UNION MENTAL HEALTH & PASTORAL COUNSELING, PLLC
Entity Type:Organization
Organization Name:UNION MENTAL HEALTH & PASTORAL COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:BIGELOW
Authorized Official - Last Name:FORMICA
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:603-673-6643
Mailing Address - Street 1:89 STATE ROUTE 101A
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NH
Mailing Address - Zip Code:03031-2290
Mailing Address - Country:US
Mailing Address - Phone:603-673-6643
Mailing Address - Fax:603-673-6620
Practice Address - Street 1:89 STATE ROUTE 101A
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NH
Practice Address - Zip Code:03031-2290
Practice Address - Country:US
Practice Address - Phone:603-673-6643
Practice Address - Fax:603-673-6620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH91101YM0800X
NHLLP#8101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty