Provider Demographics
NPI:1841256724
Name:WHITEHOUSE BRIGGS, WILLOW LILITH (MA LCPC LSP)
Entity type:Individual
Prefix:MRS
First Name:WILLOW
Middle Name:LILITH
Last Name:WHITEHOUSE BRIGGS
Suffix:
Gender:F
Credentials:MA LCPC LSP
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:ELIZABETH
Other - Last Name:WHITEHOUSE NEVILLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:FREEDOM
Mailing Address - City:FREEDOM
Mailing Address - State:NH
Mailing Address - Zip Code:03836-0216
Mailing Address - Country:US
Mailing Address - Phone:603-539-8461
Mailing Address - Fax:
Practice Address - Street 1:19 RIVER ROAD BOX318
Practice Address - Street 2:HIRAM
Practice Address - City:HIRAM
Practice Address - State:ME
Practice Address - Zip Code:04041
Practice Address - Country:US
Practice Address - Phone:207-625-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC824101YP2500X
NH80762103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME214080099Medicaid