Provider Demographics
NPI:1629468921
Name:EXPLORATION OF THE MIND COUNSELING, LLC
Entity Type:Organization
Organization Name:EXPLORATION OF THE MIND COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCMHC, MLADC
Authorized Official - Phone:603-674-6872
Mailing Address - Street 1:713 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-3002
Mailing Address - Country:US
Mailing Address - Phone:603-674-6872
Mailing Address - Fax:
Practice Address - Street 1:713 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-3002
Practice Address - Country:US
Practice Address - Phone:603-674-6872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH853101YA0400X
NH983101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty