Provider Demographics
NPI:1497462410
Name:LEVESQUE, AMANDA (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:LEVESQUE
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 1:160 OLD GREENE RD
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-2214
Mailing Address - Country:US
Mailing Address - Phone:207-576-2672
Mailing Address - Fax:
Practice Address - Street 1:1919 LISBON RD
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-1415
Practice Address - Country:US
Practice Address - Phone:207-576-2672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC5855101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional