Provider Demographics
NPI:1902930845
Name:FARRELL, CHARLES LEEMING (LCMHC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:LEEMING
Last Name:FARRELL
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 5TH ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2950
Mailing Address - Country:US
Mailing Address - Phone:603-749-4462
Mailing Address - Fax:603-749-2475
Practice Address - Street 1:16 5TH ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2950
Practice Address - Country:US
Practice Address - Phone:603-749-4462
Practice Address - Fax:603-749-2475
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH567101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health