Provider Demographics
NPI:1548699507
Name:EDGE COUNSELING LLC
Entity type:Organization
Organization Name:EDGE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:T
Authorized Official - Last Name:EDGE
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:603-860-0623
Mailing Address - Street 1:8 WASHINGTON CT
Mailing Address - Street 2:
Mailing Address - City:CENTER BARNSTEAD
Mailing Address - State:NH
Mailing Address - Zip Code:03225-3331
Mailing Address - Country:US
Mailing Address - Phone:603-860-0623
Mailing Address - Fax:603-776-1717
Practice Address - Street 1:8 WASHINGTON CT
Practice Address - Street 2:
Practice Address - City:CENTER BARNSTEAD
Practice Address - State:NH
Practice Address - Zip Code:03225-3331
Practice Address - Country:US
Practice Address - Phone:603-860-0623
Practice Address - Fax:603-776-1717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-10
Last Update Date:2013-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH834320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness