Provider Demographics
NPI:1659071512
Name:MARQUIS, SELENA MARIE (LDAC)
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:MARIE
Last Name:MARQUIS
Suffix:
Gender:F
Credentials:LDAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 MIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NH
Mailing Address - Zip Code:03584-3508
Mailing Address - Country:US
Mailing Address - Phone:603-788-5029
Mailing Address - Fax:603-788-5607
Practice Address - Street 1:8 CLOVER LN
Practice Address - Street 2:
Practice Address - City:WHITEFIELD
Practice Address - State:NH
Practice Address - Zip Code:03598-3343
Practice Address - Country:US
Practice Address - Phone:603-788-5075
Practice Address - Fax:603-788-5285
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1247101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)