Provider Demographics
NPI:1598999781
Name:VERBECK, KRISTIN (LADC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:VERBECK
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 DEPOT ST 2R
Mailing Address - Street 2:POB 1216
Mailing Address - City:WILTON
Mailing Address - State:ME
Mailing Address - Zip Code:04924
Mailing Address - Country:US
Mailing Address - Phone:207-691-2495
Mailing Address - Fax:
Practice Address - Street 1:545 DEPOT ST # 2R
Practice Address - Street 2:POB 1216
Practice Address - City:WILTON
Practice Address - State:ME
Practice Address - Zip Code:04294-6605
Practice Address - Country:US
Practice Address - Phone:207-691-2495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC4847101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)