Provider Demographics
NPI:1124391529
Name:MCNALLY, AGNES DORIS (LCPC)
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:DORIS
Last Name:MCNALLY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04274-5102
Mailing Address - Country:US
Mailing Address - Phone:207-242-2292
Mailing Address - Fax:
Practice Address - Street 1:79 MAIN ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-5811
Practice Address - Country:US
Practice Address - Phone:207-242-2292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC5005101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional