Provider Demographics
NPI:1861600280
Name:SALEM, PAUL W JR (MA, LADC, CCFC)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:W
Last Name:SALEM
Suffix:JR
Gender:M
Credentials:MA, LADC, CCFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 STARK HWY S
Mailing Address - Street 2:
Mailing Address - City:DUNBARTON
Mailing Address - State:NH
Mailing Address - Zip Code:03046-4411
Mailing Address - Country:US
Mailing Address - Phone:603-774-6909
Mailing Address - Fax:
Practice Address - Street 1:50 BRIDGE ST
Practice Address - Street 2:SUITE #104
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1699
Practice Address - Country:US
Practice Address - Phone:603-660-0584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0307101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)