Provider Demographics
NPI:1700238672
Name:LEBRUN, MELISSA L (LADC, CCS)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:L
Last Name:LEBRUN
Suffix:
Gender:F
Credentials:LADC, CCS
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:L
Other - Last Name:MOREAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:407 WHICHERS MILLS RD
Mailing Address - Street 2:
Mailing Address - City:ALFRED
Mailing Address - State:ME
Mailing Address - Zip Code:04002-3709
Mailing Address - Country:US
Mailing Address - Phone:207-432-1954
Mailing Address - Fax:
Practice Address - Street 1:302 COTTAGE STREET
Practice Address - Street 2:SUITE C # 4
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073
Practice Address - Country:US
Practice Address - Phone:207-459-4070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC5665101YA0400X
MELC6513101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)