Provider Demographics
NPI:1609837327
Name:WITMAN, DULCIE Y (LADC)
Entity Type:Individual
Prefix:MS
First Name:DULCIE
Middle Name:Y
Last Name:WITMAN
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 1:222 SAINT JOHN ST
Mailing Address - Street 2:STE 102
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102
Mailing Address - Country:US
Mailing Address - Phone:207-775-4026
Mailing Address - Fax:207-775-4026
Practice Address - Street 1:222 SAINT JOHN ST
Practice Address - Street 2:STE 102
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:207-775-4026
Practice Address - Fax:207-775-4026
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC1467101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)