Provider Demographics
NPI:1619432994
Name:POULIN, MICHELLE LEE (CRSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:POULIN
Suffix:
Gender:F
Credentials:CRSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-4311
Mailing Address - Country:US
Mailing Address - Phone:603-263-6444
Mailing Address - Fax:603-931-3719
Practice Address - Street 1:303 BELMONT ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-4311
Practice Address - Country:US
Practice Address - Phone:603-263-6444
Practice Address - Fax:603-931-3719
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0154101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)