Provider Demographics
NPI:1548223993
Name:POOL, JOANNA M (LADC)
Entity Type:Individual
Prefix:MS
First Name:JOANNA
Middle Name:M
Last Name:POOL
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:M
Other - Last Name:POOL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA LADC
Mailing Address - Street 1:142 HIGH ST
Mailing Address - Street 2:SUITE 501
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102
Mailing Address - Country:US
Mailing Address - Phone:207-773-3031
Mailing Address - Fax:
Practice Address - Street 1:142 HIGH ST
Practice Address - Street 2:SUITE 501
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:207-773-3031
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC89101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)