Provider Demographics
NPI:1750450896
Name:MITCHELL, MARIE (LCPC, CADC)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 WABANAKI WAY
Mailing Address - Street 2:
Mailing Address - City:INDIAN ISLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04468-1252
Mailing Address - Country:US
Mailing Address - Phone:207-817-7400
Mailing Address - Fax:207-827-5022
Practice Address - Street 1:23 WABANAKI WAY
Practice Address - Street 2:
Practice Address - City:INDIAN ISLAND
Practice Address - State:ME
Practice Address - Zip Code:04468-1252
Practice Address - Country:US
Practice Address - Phone:207-817-7400
Practice Address - Fax:207-827-5022
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC3261101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor