Provider Demographics
NPI:1528360435
Name:FAUGHNAN, DORIS MARIE (MLADC)
Entity Type:Individual
Prefix:MS
First Name:DORIS
Middle Name:MARIE
Last Name:FAUGHNAN
Suffix:
Gender:F
Credentials:MLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ROYAL CREST DRIVE
Mailing Address - Street 2:UNIT #12
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060
Mailing Address - Country:US
Mailing Address - Phone:603-306-6574
Mailing Address - Fax:
Practice Address - Street 1:50 GREENSBORO ROAD
Practice Address - Street 2:UNIT #109
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755
Practice Address - Country:US
Practice Address - Phone:603-306-6574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-29
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0686101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH50195Medicaid
NH3097832Medicaid