Provider Demographics
NPI:1164133229
Name:SHORELINE COUNSELING GROUP LLC
Entity Type:Organization
Organization Name:SHORELINE COUNSELING GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:MARY NELSON
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:603-836-0383
Mailing Address - Street 1:PO BOX 1604
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03821-1604
Mailing Address - Country:US
Mailing Address - Phone:603-836-0393
Mailing Address - Fax:
Practice Address - Street 1:140 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3721
Practice Address - Country:US
Practice Address - Phone:603-836-0393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-09
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1669753554OtherNPI
NH853439574OtherNPI