Provider Demographics
NPI:1184264343
Name:DUFORD, JACQUELYN TOPPER (LCMHC)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:TOPPER
Last Name:DUFORD
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:NICOLE
Other - Last Name:TOPPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:360 ROUTE 101 STE 10
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-5031
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:360 ROUTE 101 STE 10
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-5031
Practice Address - Country:US
Practice Address - Phone:603-472-2846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2218101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health