Provider Demographics
NPI:1871093971
Name:MCKENNA, CHRISTINE M (MLADC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:MCKENNA
Suffix:
Gender:M
Credentials:MLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 EPPING RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-1547
Mailing Address - Country:US
Mailing Address - Phone:603-658-0188
Mailing Address - Fax:603-418-7099
Practice Address - Street 1:133 EPPING RD UNIT B
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-1547
Practice Address - Country:US
Practice Address - Phone:603-658-0188
Practice Address - Fax:603-418-7099
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0581101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)