Provider Demographics
NPI:1851922355
Name:HOUSTON, JENNIFER IRENE (MLADC, LICSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:IRENE
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:MLADC, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 HALL ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3488
Mailing Address - Country:US
Mailing Address - Phone:603-505-8365
Mailing Address - Fax:603-369-4334
Practice Address - Street 1:81 HALL ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3488
Practice Address - Country:US
Practice Address - Phone:603-505-8365
Practice Address - Fax:603-369-4334
Is Sole Proprietor?:No
Enumeration Date:2020-02-03
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0558101YA0400X
NH22631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)