Provider Demographics
NPI:1225225170
Name:MICHAELIDES THOMAS, ADELE G (MA, LCMHC)
Entity Type:Individual
Prefix:MS
First Name:ADELE
Middle Name:G
Last Name:MICHAELIDES THOMAS
Suffix:
Gender:F
Credentials:MA, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 FEDERAL ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3632
Mailing Address - Country:US
Mailing Address - Phone:603-355-2244
Mailing Address - Fax:
Practice Address - Street 1:19 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3632
Practice Address - Country:US
Practice Address - Phone:603-355-2244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH820101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health