Provider Demographics
NPI:1538543152
Name:NOVAK, CHARLES (MLADC)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:NOVAK
Suffix:
Gender:M
Credentials:MLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 CANTON ST
Mailing Address - Street 2:3 F
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-3563
Mailing Address - Country:US
Mailing Address - Phone:603-670-5557
Mailing Address - Fax:
Practice Address - Street 1:45 CANTON ST
Practice Address - Street 2:3 F
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3563
Practice Address - Country:US
Practice Address - Phone:603-670-5557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0954101YM0800X, 101YP2500X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional