Provider Demographics
NPI:1093044935
Name:LACOURSE, GRACE ELIZABETH
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:ELIZABETH
Last Name:LACOURSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 OLD ALFRED RD
Mailing Address - Street 2:
Mailing Address - City:EAST WATERBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04030-5114
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 OLD ALFRED RD
Practice Address - Street 2:
Practice Address - City:EAST WATERBORO
Practice Address - State:ME
Practice Address - Zip Code:04030-5114
Practice Address - Country:US
Practice Address - Phone:207-247-5682
Practice Address - Fax:207-247-5682
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEALLS3315101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health