Provider Demographics
NPI:1477587574
Name:TAXTER, V. ELIZABETH (LCPC)
Entity Type:Individual
Prefix:
First Name:V. ELIZABETH
Middle Name:
Last Name:TAXTER
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 1:25 POLAND RD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-6804
Mailing Address - Country:US
Mailing Address - Phone:207-879-1011
Mailing Address - Fax:207-879-1011
Practice Address - Street 1:222 ST JOHN STREET
Practice Address - Street 2:#248
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:207-879-1011
Practice Address - Fax:207-879-1011
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC267101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health