Provider Demographics
NPI:1558801670
Name:LABYS, CHARLOTTE
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:LABYS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 BIRCH ST
Mailing Address - Street 2:204
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7415
Mailing Address - Country:US
Mailing Address - Phone:207-753-2700
Mailing Address - Fax:207-753-2701
Practice Address - Street 1:57 BIRCH ST
Practice Address - Street 2:204
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7415
Practice Address - Country:US
Practice Address - Phone:207-753-2700
Practice Address - Fax:207-753-2701
Is Sole Proprietor?:No
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1502101Y00000X, 101YM0800X, 101YP2500X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional