Provider Demographics
NPI:1992002786
Name:BICKFORD, JEFFREY (LCPC, LADC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:BICKFORD
Suffix:
Gender:M
Credentials:LCPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 WATER ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-4619
Mailing Address - Country:US
Mailing Address - Phone:207-626-3373
Mailing Address - Fax:207-626-3365
Practice Address - Street 1:295 WATER ST
Practice Address - Street 2:SUITE 8
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-4619
Practice Address - Country:US
Practice Address - Phone:207-626-3373
Practice Address - Fax:207-626-3365
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-14
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC224101YA0400X
MECC3646101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)