Provider Demographics
NPI:1598186454
Name:STABLEFORD, ERNEST MARK
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:MARK
Last Name:STABLEFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 COUNTY FARM RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-6003
Mailing Address - Country:US
Mailing Address - Phone:603-516-8167
Mailing Address - Fax:603-749-3983
Practice Address - Street 1:272 COUNTY FARM RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-6003
Practice Address - Country:US
Practice Address - Phone:603-516-8167
Practice Address - Fax:603-749-3983
Is Sole Proprietor?:No
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC3696101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)