Provider Demographics
NPI:1568095461
Name:REAGAN, AMBER (LADC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:REAGAN
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 HOLY CROSS RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03235-1910
Mailing Address - Country:US
Mailing Address - Phone:603-263-0391
Mailing Address - Fax:603-934-9815
Practice Address - Street 1:27 HOLY CROSS RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NH
Practice Address - Zip Code:03235-1910
Practice Address - Country:US
Practice Address - Phone:603-263-0391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1099101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)