Provider Demographics
NPI:1417491192
Name:ST. CLAIR, YEMAYA (LCPC-C)
Entity Type:Individual
Prefix:
First Name:YEMAYA
Middle Name:
Last Name:ST. CLAIR
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 BRACKETT ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3857
Mailing Address - Country:US
Mailing Address - Phone:206-963-7194
Mailing Address - Fax:
Practice Address - Street 1:177 BRACKETT ST
Practice Address - Street 2:SUITE B
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3857
Practice Address - Country:US
Practice Address - Phone:206-963-7194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4807101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health