Provider Demographics
NPI:1164791034
Name:POOLE, VALERIE M (LADC)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:M
Last Name:POOLE
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:M
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LADC
Mailing Address - Street 1:PO BOX 8102
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04243-8102
Mailing Address - Country:US
Mailing Address - Phone:207-485-9020
Mailing Address - Fax:
Practice Address - Street 1:190 BATES ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7329
Practice Address - Country:US
Practice Address - Phone:207-485-9020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-22
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC5227101YA0400X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MELC5227OtherNEW LICENSE (ME)