Provider Demographics
NPI:1124700026
Name:BRAVE SOBRIETY AND WELLNESS
Entity type:Organization
Organization Name:BRAVE SOBRIETY AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:MACKENZIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SEELY
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW MLADC
Authorized Official - Phone:603-581-8090
Mailing Address - Street 1:23 PLUMMER ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-1237
Mailing Address - Country:US
Mailing Address - Phone:603-581-8090
Mailing Address - Fax:
Practice Address - Street 1:23 PLUMMER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-1237
Practice Address - Country:US
Practice Address - Phone:160-358-1809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty