Provider Demographics
NPI:1336620723
Name:JOVANOVICH, KRISTIAN DUSHAN
Entity Type:Individual
Prefix:
First Name:KRISTIAN
Middle Name:DUSHAN
Last Name:JOVANOVICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HALL ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3408
Mailing Address - Country:US
Mailing Address - Phone:603-229-4260
Mailing Address - Fax:
Practice Address - Street 1:100 HALL ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3408
Practice Address - Country:US
Practice Address - Phone:603-229-4260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1151101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)