Provider Demographics
NPI:1669532115
Name:DERRY COUNSELING SVCS
Entity type:Organization
Organization Name:DERRY COUNSELING SVCS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNER WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC NH 161
Authorized Official - Phone:603-434-5672
Mailing Address - Street 1:4 BIRCH ST
Mailing Address - Street 2:STE 201
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038
Mailing Address - Country:US
Mailing Address - Phone:603-434-5672
Mailing Address - Fax:603-434-5672
Practice Address - Street 1:4 BIRCH ST
Practice Address - Street 2:STE 201
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038
Practice Address - Country:US
Practice Address - Phone:603-434-5672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80001811Medicaid
NH30421663Medicaid
NH30421663Medicaid