Provider Demographics
NPI:1508932963
Name:DVORAK, LOIS C (LCPC)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:C
Last Name:DVORAK
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 1:256 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:OLD TOWN
Mailing Address - State:ME
Mailing Address - Zip Code:04468-5905
Mailing Address - Country:US
Mailing Address - Phone:207-827-3087
Mailing Address - Fax:
Practice Address - Street 1:6 STATE ST
Practice Address - Street 2:SUITE 610
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5112
Practice Address - Country:US
Practice Address - Phone:207-947-2292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC00001174101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional