Provider Demographics
NPI:1558485292
Name:DEFORREST, LINDA GAIL (LCMHC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:GAIL
Last Name:DEFORREST
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 LOCK ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03064-2823
Mailing Address - Country:US
Mailing Address - Phone:603-882-2866
Mailing Address - Fax:
Practice Address - Street 1:72 LOCK ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03064-2823
Practice Address - Country:US
Practice Address - Phone:603-882-2866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH628101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health