Provider Demographics
NPI:1821327644
Name:MUNCEY, DOROTHY (LADC CCS)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:MUNCEY
Suffix:
Gender:F
Credentials:LADC CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:ME
Mailing Address - Zip Code:04457-1458
Mailing Address - Country:US
Mailing Address - Phone:207-794-6166
Mailing Address - Fax:207-794-6166
Practice Address - Street 1:52 MAIN ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457-1458
Practice Address - Country:US
Practice Address - Phone:207-794-6166
Practice Address - Fax:207-794-6166
Is Sole Proprietor?:No
Enumeration Date:2009-12-08
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC3947101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432564499Medicaid