Provider Demographics
NPI:1225814817
Name:BISSONNETTE, LAURYN MARIE (LCPC-C)
Entity Type:Individual
Prefix:
First Name:LAURYN
Middle Name:MARIE
Last Name:BISSONNETTE
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 1:121 COMMERCIAL ST APT 3
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-4731
Mailing Address - Country:US
Mailing Address - Phone:207-620-2680
Mailing Address - Fax:
Practice Address - Street 1:24 STONE ST STE 201
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5209
Practice Address - Country:US
Practice Address - Phone:207-922-4600
Practice Address - Fax:207-623-3722
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL7237101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional