Provider Demographics
NPI:1376190173
Name:HART, ALLISON LESLIE (LCPC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:LESLIE
Last Name:HART
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 FOREST AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-6403
Mailing Address - Country:US
Mailing Address - Phone:207-910-6580
Mailing Address - Fax:
Practice Address - Street 1:1250 FOREST AVE STE 201
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-6403
Practice Address - Country:US
Practice Address - Phone:207-910-6580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC6219101YM0800X
MEXL5078101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health