Provider Demographics
NPI:1952402851
Name:CHARLAND, CLARISSE A (MED, MLADC)
Entity Type:Individual
Prefix:
First Name:CLARISSE
Middle Name:A
Last Name:CHARLAND
Suffix:
Gender:F
Credentials:MED, MLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 MAPLE ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HOPKINTON
Mailing Address - State:NH
Mailing Address - Zip Code:03229-3377
Mailing Address - Country:US
Mailing Address - Phone:603-863-8956
Mailing Address - Fax:
Practice Address - Street 1:633 MAPLE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:HOPKINTON
Practice Address - State:NH
Practice Address - Zip Code:03229-3377
Practice Address - Country:US
Practice Address - Phone:603-863-8956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH492101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)