Provider Demographics
NPI:1639332638
Name:WATERS, DOROTHY JEAN (MSW LADC)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:JEAN
Last Name:WATERS
Suffix:
Gender:F
Credentials:MSW LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 PORTSMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:GREENLAND
Mailing Address - State:NH
Mailing Address - Zip Code:03840-2257
Mailing Address - Country:US
Mailing Address - Phone:603-422-8844
Mailing Address - Fax:
Practice Address - Street 1:526 PORTSMOUTH AVE
Practice Address - Street 2:
Practice Address - City:GREENLAND
Practice Address - State:NH
Practice Address - Zip Code:03840-2257
Practice Address - Country:US
Practice Address - Phone:603-422-8844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0594101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0594OtherLICENSE ALCOGOL AND DRUG COUNSELOR