Provider Demographics
NPI:1184024192
Name:BUCHANAN, MELISSA R (LCPC-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:R
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 WOODLANDS PT RD
Mailing Address - Street 2:
Mailing Address - City:WEST BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530-6342
Mailing Address - Country:US
Mailing Address - Phone:207-389-4474
Mailing Address - Fax:
Practice Address - Street 1:6 OAK GROVE AVE
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-2205
Practice Address - Country:US
Practice Address - Phone:207-389-4474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4309101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional