Individual
MISS LISA GAY WITHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
226 ROCKINGHAM RD, LONDONDERRY, NH 03053-2170
(603) 425-2989
(603) 425-2978
Mailing address
101 ASPETUCK AVE., CANTERBURY SCHOOL, NEW MILFORD, NH 06776
(860) 389-3110
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
1247
NH
2255A2300X
Athletic Trainer
Primary
000280
CT
Other
Enumeration date
02/27/2007
Last updated
12/23/2020
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