Provider Demographics
NPI:1093121501
Name:MAGUIRE, GRACELYN (LCPC-C, LADC)
Entity Type:Individual
Prefix:
First Name:GRACELYN
Middle Name:
Last Name:MAGUIRE
Suffix:
Gender:F
Credentials:LCPC-C, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 TOWN HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:WEST GARDINER
Mailing Address - State:ME
Mailing Address - Zip Code:04345-3402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16 TOWN HOUSE RD
Practice Address - Street 2:
Practice Address - City:WEST GARDINER
Practice Address - State:ME
Practice Address - Zip Code:04345-3402
Practice Address - Country:US
Practice Address - Phone:207-624-1089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-03
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LC5643101YA0400X
MEXL4176101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)