Provider Demographics
NPI:1659559839
Name:GOSSELIN, CARRIE (MA, LCPC)
Entity Type:Individual
Prefix:MISS
First Name:CARRIE
Middle Name:
Last Name:GOSSELIN
Suffix:
Gender:F
Credentials:MA, 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 2008
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04241-2008
Mailing Address - Country:US
Mailing Address - Phone:207-783-9141
Mailing Address - Fax:207-376-3808
Practice Address - Street 1:1155 LISBON ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5025
Practice Address - Country:US
Practice Address - Phone:207-783-9141
Practice Address - Fax:207-376-3808
Is Sole Proprietor?:No
Enumeration Date:2008-02-10
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC3842101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1659559839Medicaid