Provider Demographics
NPI:1558609842
Name:THIBEAULT, FAITHANNA MAY (LCMHC)
Entity Type:Individual
Prefix:
First Name:FAITHANNA
Middle Name:MAY
Last Name:THIBEAULT
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 1:3 ATWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03784-1401
Mailing Address - Country:US
Mailing Address - Phone:603-518-4073
Mailing Address - Fax:
Practice Address - Street 1:3 ATWOOD AVE
Practice Address - Street 2:
Practice Address - City:WEST LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03784-1401
Practice Address - Country:US
Practice Address - Phone:603-518-4073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH969101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health