Provider Demographics
NPI:1275280877
Name:EDMONDS, SUSAN MARIE (MA, LCMHC, MLADC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:EDMONDS
Suffix:
Gender:F
Credentials:MA, LCMHC, MLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 TRAFALGAR SQ STE 270
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-1900
Mailing Address - Country:US
Mailing Address - Phone:870-544-4094
Mailing Address - Fax:603-386-6260
Practice Address - Street 1:9 TRAFALGAR SQ STE 270
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-1900
Practice Address - Country:US
Practice Address - Phone:870-544-4094
Practice Address - Fax:603-386-6260
Is Sole Proprietor?:No
Enumeration Date:2022-03-04
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1278101YA0400X
NH2677101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)