Provider Demographics
NPI:1245525609
Name:MCCORMICK, THISVI (LCMHC, MLADC)
Entity type:Individual
Prefix:
First Name:THISVI
Middle Name:
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:LCMHC, MLADC
Other - Prefix:
Other - First Name:THISVI
Other - Middle Name:
Other - Last Name:MCCORMICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCMHC, MLADC
Mailing Address - Street 1:32 OLD WELLINGTON RD # 287
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-4518
Mailing Address - Country:US
Mailing Address - Phone:603-203-5478
Mailing Address - Fax:
Practice Address - Street 1:32 OLD WELLINGTON RD # 287
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-4518
Practice Address - Country:US
Practice Address - Phone:603-203-5478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH807101YA0400X, 174400000X
NH2251101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No174400000XOther Service ProvidersSpecialist