Provider Demographics
NPI:1629218847
Name:JOUBERT, MICHELLE MARIE (MA, BC-DMT, CHC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MARIE
Last Name:JOUBERT
Suffix:
Gender:F
Credentials:MA, BC-DMT, CHC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:MARIE
Other - Last Name:GAUDREAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:50 DEPOT RD STE 2
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1211
Mailing Address - Country:US
Mailing Address - Phone:207-835-3616
Mailing Address - Fax:
Practice Address - Street 1:110 MAIN ST STE 1508
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-3517
Practice Address - Country:US
Practice Address - Phone:207-200-1445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-27
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6905101YM0800X, 101YS0200X
MECC4207101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool