Provider Demographics
NPI:1972006443
Name:CHAMPAGNE, HUNTER (LMHC)
Entity Type:Individual
Prefix:
First Name:HUNTER
Middle Name:
Last Name:CHAMPAGNE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:GUILDERLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12084-9210
Mailing Address - Country:US
Mailing Address - Phone:610-825-9400
Mailing Address - Fax:610-825-7130
Practice Address - Street 1:2280 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:GUILDERLAND
Practice Address - State:NY
Practice Address - Zip Code:12084-9210
Practice Address - Country:US
Practice Address - Phone:518-456-5056
Practice Address - Fax:518-456-6512
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-12
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012752-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health