Provider Demographics
NPI:1366513053
Name:CHARLES, PAULA M (LADC)
Entity type:Individual
Prefix:MS
First Name:PAULA
Middle Name:M
Last Name:CHARLES
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 MAIN ST STE 110
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-2707
Mailing Address - Country:US
Mailing Address - Phone:603-595-9499
Mailing Address - Fax:603-595-9499
Practice Address - Street 1:120 MAIN ST STE 110
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-2707
Practice Address - Country:US
Practice Address - Phone:603-595-9499
Practice Address - Fax:603-595-9499
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH249101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)