Provider Demographics
NPI:1497066716
Name:GEBHARDT, SARE (LCPC-C)
Entity Type:Individual
Prefix:
First Name:SARE
Middle Name:
Last Name:GEBHARDT
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 1:79 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-5811
Mailing Address - Country:US
Mailing Address - Phone:207-784-3811
Mailing Address - Fax:207-407-1107
Practice Address - Street 1:79 MAIN ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-5811
Practice Address - Country:US
Practice Address - Phone:207-784-3811
Practice Address - Fax:207-407-1107
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL3550101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health