Provider Demographics
NPI:1194179895
Name:ELDREDGE, JOHN (MSW, MLADC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:ELDREDGE
Suffix:
Gender:M
Credentials:MSW, MLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 GROVE ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-3334
Mailing Address - Country:US
Mailing Address - Phone:603-235-1489
Mailing Address - Fax:
Practice Address - Street 1:10 GROVE ST UNIT A
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3334
Practice Address - Country:US
Practice Address - Phone:603-235-1489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0981101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)