Provider Demographics
NPI:1518292200
Name:COWAN, DOUGLAS ANDREW (LCPC, LADC)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:ANDREW
Last Name:COWAN
Suffix:
Gender:M
Credentials:LCPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 4693
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04112
Mailing Address - Country:US
Mailing Address - Phone:207-650-2632
Mailing Address - Fax:207-767-0995
Practice Address - Street 1:131 SPRING ST.
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101
Practice Address - Country:US
Practice Address - Phone:207-650-2632
Practice Address - Fax:207-767-0995
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-14
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC3002101Y00000X, 101YA0400X
MECC2708101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432729499Medicaid