Active NPI
Molly Ann Vaillincourt, LICSW, MLADC
- Mental Health Counselor
- Dover, NH
National Provider Identifier
1063973824
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 2237
- Practice address
- 1 Washington St
Dover, NH 03820-3848 - Phone
- (603) 945-8390
- NPI assigned
- Mar 26, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 1064 | NH | |
| Clinical Social Worker | 1041C0700X | 2237 | NH | |
| Mental Health Counselor | 101YM0800X | 2237 | NH | Primary |
Addresses
Primary practice location
1 Washington St
Dover, NH 03820-3848
Mailing address
2 Burnham Ave
Durham, NH 03824-3011
Phone (603) 892-2699
Other practice location 1
323 Gonic Rd
Rochester, NH 03839-5686
Phone (603) 332-8000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3097970 | Medicaid | NH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1064 | NH | MD | Addiction (Substance Use Disorder) Counselor |
| 2237 | NH | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1553558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615593600000",
"number": "1063973824",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 BURNHAM AVE",
"city": "DURHAM",
"state": "NH",
"postal_code": "038243011",
"telephone_number": "603-892-2699"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 WASHINGTON ST",
"city": "DOVER",
"state": "NH",
"postal_code": "038203848",
"telephone_number": "603-945-8390"
}
],
"practiceLocations": [
{
"address_1": "323 Gonic Rd",
"address_purpose": "LOCATION",
"city": "Rochester",
"state": "NH",
"postal_code": "038395686",
"country_code": "US",
"telephone_number": "603-332-8000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "VAILLINCOURT",
"first_name": "MOLLY",
"middle_name": "ANN",
"credential": "LICSW, MLADC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-03-26",
"last_updated": "2021-03-13",
"certification_date": "2021-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NH",
"license": "1064",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NH",
"license": "2237",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NH",
"license": "2237",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3097970",
"state": "NH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dover, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.