Provider Demographics
NPI:1336316660
Name:HINSCH, SALLY A (MA, LCPC)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:A
Last Name:HINSCH
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 140
Mailing Address - Street 2:
Mailing Address - City:WALDOBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04572-0140
Mailing Address - Country:US
Mailing Address - Phone:208-927-0287
Mailing Address - Fax:208-620-3939
Practice Address - Street 1:251 JEFFERSON ST # 201
Practice Address - Street 2:
Practice Address - City:WALDOBORO
Practice Address - State:ME
Practice Address - Zip Code:04572-6011
Practice Address - Country:US
Practice Address - Phone:208-927-0287
Practice Address - Fax:208-620-3939
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-6197101YM0800X
MECC6533101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDLCPC-6197OtherPROFESSIONAL LICENSE
MECC6533OtherPROFESSIONAL LICENSE