Provider Demographics
NPI:1376861468
Name:FORD, LORI LEE (MS,MLADC)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:LEE
Last Name:FORD
Suffix:
Gender:F
Credentials:MS,MLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 A APPLETREE DR.
Mailing Address - Street 2:
Mailing Address - City:GOFFSTOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03045
Mailing Address - Country:US
Mailing Address - Phone:603-470-6937
Mailing Address - Fax:
Practice Address - Street 1:38A APPLE TREE DR
Practice Address - Street 2:
Practice Address - City:GOFFSTOWN
Practice Address - State:NH
Practice Address - Zip Code:03045-2110
Practice Address - Country:US
Practice Address - Phone:603-470-6937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH683101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)