Provider Demographics
NPI:1245229780
Name:DUCHARME, KIMBERLY DAWN (MLADC)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:DAWN
Last Name:DUCHARME
Suffix:
Gender:F
Credentials:MLADC
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:DAWN
Other - Last Name:DUCHARME
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MLADC
Mailing Address - Street 1:20 PETER RD
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-4543
Mailing Address - Country:US
Mailing Address - Phone:036-661-1625
Mailing Address - Fax:
Practice Address - Street 1:700 LAKE AVE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103
Practice Address - Country:US
Practice Address - Phone:603-263-6303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0970101YA0400X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor