Provider Demographics
NPI:1952703647
Name:SELF-EMPOWERMENT-NH LLC
Entity Type:Organization
Organization Name:SELF-EMPOWERMENT-NH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUBSTANCE ABUSE COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MAGOON
Authorized Official - Suffix:
Authorized Official - Credentials:MLADC
Authorized Official - Phone:603-470-6937
Mailing Address - Street 1:85 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3837
Mailing Address - Country:US
Mailing Address - Phone:603-470-6937
Mailing Address - Fax:603-856-8240
Practice Address - Street 1:85 WARREN ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3837
Practice Address - Country:US
Practice Address - Phone:603-470-6937
Practice Address - Fax:603-856-8240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0683101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty