Provider Demographics
NPI:1578177044
Name:DEBOIS, MOIRA CHRISTINE
Entity Type:Individual
Prefix:
First Name:MOIRA
Middle Name:CHRISTINE
Last Name:DEBOIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2975 DARTMOUTH COLLEGE HWY STE 1
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVERHILL
Mailing Address - State:NH
Mailing Address - Zip Code:03774-4535
Mailing Address - Country:US
Mailing Address - Phone:603-787-2150
Mailing Address - Fax:
Practice Address - Street 1:2975 DARTMOUTH COLLEGE HWY STE 1
Practice Address - Street 2:
Practice Address - City:NORTH HAVERHILL
Practice Address - State:NH
Practice Address - Zip Code:03774-4535
Practice Address - Country:US
Practice Address - Phone:603-787-2150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH54633103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist