Provider Demographics
NPI:1942636378
Name:LEBISH, JAMES HOWARD (CADC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:HOWARD
Last Name:LEBISH
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 GRANT ST
Mailing Address - Street 2:#24
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2154
Mailing Address - Country:US
Mailing Address - Phone:207-774-3099
Mailing Address - Fax:
Practice Address - Street 1:157 GRANT ST
Practice Address - Street 2:#24
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2154
Practice Address - Country:US
Practice Address - Phone:207-774-3099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC4357101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)