Provider Demographics
NPI:1780685511
Name:HOLBROOK, MARK I (LCPC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:I
Last Name:HOLBROOK
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 1:13 GURNET RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2767
Mailing Address - Country:US
Mailing Address - Phone:207-373-1480
Mailing Address - Fax:
Practice Address - Street 1:130 GIVEN SHIPYARD RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3804
Practice Address - Country:US
Practice Address - Phone:207-373-1480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC 2358101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional