Provider Demographics
NPI:1568508778
Name:AYOTTE, JEANNINE (SA COUNSELOR LADC)
Entity Type:Individual
Prefix:
First Name:JEANNINE
Middle Name:
Last Name:AYOTTE
Suffix:
Gender:F
Credentials:SA COUNSELOR LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 MARKET ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT KENT
Mailing Address - State:ME
Mailing Address - Zip Code:04743-1410
Mailing Address - Country:US
Mailing Address - Phone:207-834-3186
Mailing Address - Fax:207-834-7190
Practice Address - Street 1:139 MARKET ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT KENT
Practice Address - State:ME
Practice Address - Zip Code:04743-1410
Practice Address - Country:US
Practice Address - Phone:207-834-3186
Practice Address - Fax:207-834-7190
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC144101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)