Provider Demographics
NPI:1194917401
Name:DAVIDSON, ROSS WHITNEY (LCMHC, MLADC)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:WHITNEY
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:LCMHC, MLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03444-8102
Mailing Address - Country:US
Mailing Address - Phone:603-831-8000
Mailing Address - Fax:603-912-7607
Practice Address - Street 1:489 MAIN ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:NH
Practice Address - Zip Code:03444-8102
Practice Address - Country:US
Practice Address - Phone:603-831-8000
Practice Address - Fax:603-912-7607
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH985101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3089977Medicaid