Provider Demographics
NPI:1114021706
Name:DAVISON, CAROLINE LOUISE (LCPC)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:LOUISE
Last Name:DAVISON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:LOUISE
Other - Last Name:BIAGIOTTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:78 ATLANTIC PL
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2316
Mailing Address - Country:US
Mailing Address - Phone:207-842-7701
Mailing Address - Fax:207-842-7773
Practice Address - Street 1:12 WESTBROOK CMN
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-2819
Practice Address - Country:US
Practice Address - Phone:207-856-1500
Practice Address - Fax:207-856-1518
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC3147101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME418000099Medicaid