Provider Demographics
NPI:1306186242
Name:SMITH, NICHOLAS (LCPC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:NICHOLAS
Other - Middle Name:
Other - Last Name:CREIGHTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC
Mailing Address - Street 1:273 MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-6753
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:273 MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6753
Practice Address - Country:US
Practice Address - Phone:207-239-5027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC4610101YP2500X
MELC5774101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)