Provider Demographics
NPI:1205392461
Name:MAYNARD, TERESSA A (LADC)
Entity Type:Individual
Prefix:
First Name:TERESSA
Middle Name:A
Last Name:MAYNARD
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:TERESSA
Other - Middle Name:A
Other - Last Name:CORBIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRSW
Mailing Address - Street 1:PO BOX 3677
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03061-3677
Mailing Address - Country:US
Mailing Address - Phone:036-577-7900
Mailing Address - Fax:603-577-7972
Practice Address - Street 1:268 MAIN ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-2949
Practice Address - Country:US
Practice Address - Phone:603-402-2056
Practice Address - Fax:603-577-3122
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1296101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)