Provider Demographics
NPI:1629133939
Name:GAUVIN, DEBRA A (LCPC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:GAUVIN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 422
Mailing Address - Street 2:ACADIA HOSPITAL CORP
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-0422
Mailing Address - Country:US
Mailing Address - Phone:207-973-6100
Mailing Address - Fax:207-973-6109
Practice Address - Street 1:268 STILLWATER AVENUE
Practice Address - Street 2:ACADIA HOSPITAL CORP
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-973-6100
Practice Address - Fax:207-973-6109
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL2959101YP2500X
MECC3262101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional