Provider Demographics
NPI:1518977891
Name:MCCOMB, MICHELLE (LCPC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MCCOMB
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 1:35 WESTERN AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-7366
Mailing Address - Country:US
Mailing Address - Phone:207-432-4757
Mailing Address - Fax:207-204-1400
Practice Address - Street 1:35 WESTERN AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-7366
Practice Address - Country:US
Practice Address - Phone:207-432-4757
Practice Address - Fax:207-204-1400
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC3311101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431958399Medicaid