Provider Demographics
NPI:1326093295
Name:MCCAIN, DAVID MATTHEWS
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MATTHEWS
Last Name:MCCAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:MCCAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:63A WILSON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-4448
Mailing Address - Country:US
Mailing Address - Phone:207-771-8833
Mailing Address - Fax:
Practice Address - Street 1:650 MAIN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-5448
Practice Address - Country:US
Practice Address - Phone:207-774-4564
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC1755101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health