Provider Demographics
NPI:1598908162
Name:MT. WASHINGTON VALLEY - ADDICTION TREATMENT SOLUTIONS
Entity Type:Organization
Organization Name:MT. WASHINGTON VALLEY - ADDICTION TREATMENT SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOW
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC, LADC
Authorized Official - Phone:603-356-0020
Mailing Address - Street 1:PO BOX 1818
Mailing Address - Street 2:
Mailing Address - City:NORTH CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03860-1818
Mailing Address - Country:US
Mailing Address - Phone:603-356-0020
Mailing Address - Fax:603-356-0021
Practice Address - Street 1:2617 WHITE MOUNTAIN HIGHWAY
Practice Address - Street 2:3RD FLOOR
Practice Address - City:N. CONWAY
Practice Address - State:NH
Practice Address - Zip Code:30860
Practice Address - Country:US
Practice Address - Phone:603-356-0020
Practice Address - Fax:603-356-0021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health