Provider Demographics
NPI:1740052307
Name:KEARSARGE VALLEY COUNSELING, PLLC
Entity type:Organization
Organization Name:KEARSARGE VALLEY COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WENGER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:802-230-7760
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:WILMOT
Mailing Address - State:NH
Mailing Address - Zip Code:03287-0012
Mailing Address - Country:US
Mailing Address - Phone:802-230-7760
Mailing Address - Fax:
Practice Address - Street 1:136 STONE BRIDGE RD
Practice Address - Street 2:
Practice Address - City:WILMOT
Practice Address - State:NH
Practice Address - Zip Code:03287-4626
Practice Address - Country:US
Practice Address - Phone:802-230-7760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-26
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health