Provider Demographics
NPI:1811246218
Name:WEAVER, TRACI L (LCMHC, MLADC)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:L
Last Name:WEAVER
Suffix:
Gender:F
Credentials: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:PO BOX 194
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NH
Mailing Address - Zip Code:03049-0194
Mailing Address - Country:US
Mailing Address - Phone:603-459-9462
Mailing Address - Fax:603-595-0758
Practice Address - Street 1:2 WELLMAN AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03064-1463
Practice Address - Country:US
Practice Address - Phone:603-459-9462
Practice Address - Fax:603-595-0758
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NH1039101YM0800X
NH0910101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health