Provider Demographics
NPI:1972992428
Name:AVERILL, CHRISTINE ALICE (MLADC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ALICE
Last Name:AVERILL
Suffix:
Gender:F
Credentials:MLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 COURT ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-4306
Mailing Address - Country:US
Mailing Address - Phone:603-225-5445
Mailing Address - Fax:603-226-4690
Practice Address - Street 1:4 COURT ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4306
Practice Address - Country:US
Practice Address - Phone:603-225-5445
Practice Address - Fax:603-226-4690
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0471101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)