Basic Information
| Provider Information | |||||||||
| NPI: | 1811246218 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEAVER | ||||||||
| FirstName: | TRACI | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | LCMHC, MLADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 194 | ||||||||
| Address2: | |||||||||
| City: | HOLLIS | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030490194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034599462 | ||||||||
| FaxNumber: | 6035950758 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 WELLMAN AVE | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030641463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034599462 | ||||||||
| FaxNumber: | 6035950758 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2012 | ||||||||
| LastUpdateDate: | 12/26/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 1039 | NH | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YA0400X | 0910 | NH | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.