Provider Demographics
NPI:1417093444
Name:VALLIERE, CONNIE THERESE (LCPC)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:THERESE
Last Name:VALLIERE
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 1:5 BLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:HALLOWELL
Mailing Address - State:ME
Mailing Address - Zip Code:04347-1201
Mailing Address - Country:US
Mailing Address - Phone:207-621-1762
Mailing Address - Fax:207-582-2625
Practice Address - Street 1:17 BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:GARDINER
Practice Address - State:ME
Practice Address - Zip Code:04345-2123
Practice Address - Country:US
Practice Address - Phone:207-582-2625
Practice Address - Fax:207-582-2625
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC1696101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional