Provider Demographics
NPI:1760779128
Name:DYER, LUWANA NESSA (LCPC-C)
Entity Type:Individual
Prefix:MRS
First Name:LUWANA
Middle Name:NESSA
Last Name:DYER
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 MAIN ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-6738
Mailing Address - Country:US
Mailing Address - Phone:207-333-3394
Mailing Address - Fax:207-333-3395
Practice Address - Street 1:465 MAIN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6738
Practice Address - Country:US
Practice Address - Phone:207-333-3394
Practice Address - Fax:207-333-3395
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL3820101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEXL3820OtherLICENSE NUMBER