Doctor Name: | FAITHANNA MAY THIBEAULT |
NPI Number: | 1558609842 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCMHC |
License Number: | 969 |
Business Practice Address: | 3 Atwood Ave West Lebanon, NH - 037841401 |
Business Phone Number: | 6035184073 |
Business Fax Number: | |
Mailing Address: | 3 Atwood Ave, WEST LEBANON |
State: | NH |
Postal Code: | 037841401 |
Phone Number: | 6035184073 |
Fax Number: | |
NPI Enumeration Date: | 01/22/2013 |
NPI Last Update Date: | 01/22/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 969 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |