Provider Demographics
NPI:1700087509
Name:EVERGREEN COUNSELING SVS.,
Entity Type:Organization
Organization Name:EVERGREEN COUNSELING SVS.,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GULDENSTERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-626-5400
Mailing Address - Street 1:82 PALOMINO LN
Mailing Address - Street 2:SUITE 702
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6448
Mailing Address - Country:US
Mailing Address - Phone:603-626-5400
Mailing Address - Fax:
Practice Address - Street 1:82 PALOMINO LN
Practice Address - Street 2:SUITE 702
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6448
Practice Address - Country:US
Practice Address - Phone:603-626-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30007116Medicaid