Provider Demographics
NPI:1376772210
Name:MACOMBER COUNSELING SERVICES, P.A., L.L.C.
Entity Type:Organization
Organization Name:MACOMBER COUNSELING SERVICES, P.A., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:MACOMBER
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-229-5354
Mailing Address - Street 1:333 LINCOLN ST # 141
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-3113
Mailing Address - Country:US
Mailing Address - Phone:207-229-5354
Mailing Address - Fax:207-510-7674
Practice Address - Street 1:333 LINCOLN ST # 141
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-3113
Practice Address - Country:US
Practice Address - Phone:207-229-5354
Practice Address - Fax:207-510-7674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC7873251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health