Provider Demographics
NPI:1841530367
Name:HUCKINS, MARTHA JAYNE (LCMHC, MLADC)
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:JAYNE
Last Name:HUCKINS
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 1:103 ROXBURY ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431
Mailing Address - Country:US
Mailing Address - Phone:603-903-5643
Mailing Address - Fax:603-338-0332
Practice Address - Street 1:103 ROXBURY ST
Practice Address - Street 2:SUITE 206
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431
Practice Address - Country:US
Practice Address - Phone:603-903-5643
Practice Address - Fax:603-338-0332
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-20
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1978101Y00000X
NH0871101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3106784Medicaid