Provider Demographics
NPI:1528696945
Name:SEXTON-DIRANIAN, CHARLES QUALTERS (LADC II)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:QUALTERS
Last Name:SEXTON-DIRANIAN
Suffix:
Gender:M
Credentials:LADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:MA
Mailing Address - Zip Code:01469-1302
Mailing Address - Country:US
Mailing Address - Phone:978-868-8016
Mailing Address - Fax:
Practice Address - Street 1:491 AMHERST ST STE 105
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-1259
Practice Address - Country:US
Practice Address - Phone:603-965-2567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14340101YA0400X
NH1101101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)