Provider Demographics
NPI:1720397748
Name:CONDON, RICKY P (LCPC)
Entity Type:Individual
Prefix:MR
First Name:RICKY
Middle Name:P
Last Name:CONDON
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 MAIN ST
Mailing Address - Street 2:SUITE 190
Mailing Address - City:WILTON
Mailing Address - State:ME
Mailing Address - Zip Code:04294-3044
Mailing Address - Country:US
Mailing Address - Phone:207-592-0741
Mailing Address - Fax:
Practice Address - Street 1:284 MAIN ST
Practice Address - Street 2:SUITE 190
Practice Address - City:WILTON
Practice Address - State:ME
Practice Address - Zip Code:04294-3044
Practice Address - Country:US
Practice Address - Phone:207-592-0741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-26
Last Update Date:2010-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC885101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional