Provider Demographics
NPI:1730282856
Name:FALL, GRETCHEN (LCPC, CADC)
Entity Type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:
Last Name:FALL
Suffix:
Gender:F
Credentials:LCPC, CADC
Other - Prefix:MRS
Other - First Name:GRETCHEN
Other - Middle Name:
Other - Last Name:FALL SAWYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC, CADC
Mailing Address - Street 1:PO BOX 904
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:ME
Mailing Address - Zip Code:04217
Mailing Address - Country:US
Mailing Address - Phone:207-595-4564
Mailing Address - Fax:
Practice Address - Street 1:235 MAIN ST
Practice Address - Street 2:COMMON GROUND COUNSELING
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268-5943
Practice Address - Country:US
Practice Address - Phone:207-739-2644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC3327101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional