Provider Demographics
NPI:1275652752
Name:MCGRAW, CONSTANCE A (LADC)
Entity Type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:A
Last Name:MCGRAW
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 CHESTNUT STREET
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104
Mailing Address - Country:US
Mailing Address - Phone:603-540-0237
Mailing Address - Fax:603-668-9922
Practice Address - Street 1:713 CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104
Practice Address - Country:US
Practice Address - Phone:603-540-0237
Practice Address - Fax:603-668-9922
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0418101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)