Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 4 | NH |
N | 101YP1600X | Pastoral Counselor | 48 | NH |
NPI | 1114941242 |
---|---|
Provider Name | Mr. Paul E Groleau |
First Address | Manchester, NH 03101-1217 |
Second Address | Manchester, NH 03101-1217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30006921 | (05) | NH |