Provider Demographics
NPI:1194359950
Name:CONSTANT, ATKA BOL
Entity type:Individual
Prefix:
First Name:ATKA
Middle Name:BOL
Last Name:CONSTANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 MICOL RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NH
Mailing Address - Zip Code:03275-3114
Mailing Address - Country:US
Mailing Address - Phone:603-858-2350
Mailing Address - Fax:
Practice Address - Street 1:194 PLEASANT ST STE 2
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2952
Practice Address - Country:US
Practice Address - Phone:603-471-7791
Practice Address - Fax:877-754-5246
Is Sole Proprietor?:No
Enumeration Date:2020-03-02
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NH12476404103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician