Provider Demographics
NPI:1821182122
Name:ATLANTIC BEHAVIORAL MEDICINE INC
Entity Type:Organization
Organization Name:ATLANTIC BEHAVIORAL MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCCOUL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:603-513-1598
Mailing Address - Street 1:6 CHENELL DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-8514
Mailing Address - Country:US
Mailing Address - Phone:603-513-1598
Mailing Address - Fax:603-513-1585
Practice Address - Street 1:6 CHENELL DR
Practice Address - Street 2:SUITE 250
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-8514
Practice Address - Country:US
Practice Address - Phone:603-513-1598
Practice Address - Fax:603-513-1585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH205101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty