Provider Demographics
NPI:1467768952
Name:DYER, SHELLY MARIE (LCPC-CC)
Entity Type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:MARIE
Last Name:DYER
Suffix:
Gender:F
Credentials:LCPC-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1096 OHIO STREET
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-2763
Mailing Address - Country:US
Mailing Address - Phone:207-478-4360
Mailing Address - Fax:
Practice Address - Street 1:1096 OHIO ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-2850
Practice Address - Country:US
Practice Address - Phone:207-478-4360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-23
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4006101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional