Provider Demographics
NPI:1508172925
Name:WINN, SHASTA (MA, MLADC)
Entity Type:Individual
Prefix:
First Name:SHASTA
Middle Name:
Last Name:WINN
Suffix:
Gender:F
Credentials:MA, MLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 BRIDGE ST
Mailing Address - Street 2:UNIT I
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-3576
Mailing Address - Country:US
Mailing Address - Phone:603-512-7429
Mailing Address - Fax:
Practice Address - Street 1:46 BRIDGE ST
Practice Address - Street 2:UNIT I
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3576
Practice Address - Country:US
Practice Address - Phone:603-512-7429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-23
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0819101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3097509Medicaid