Provider Demographics
NPI:1003223702
Name:DADURA, ANNE MARIE (LCPC)
Entity type:Individual
Prefix:
First Name:ANNE MARIE
Middle Name:
Last Name:DADURA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BRISTOL CT
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-6957
Mailing Address - Country:US
Mailing Address - Phone:512-418-6222
Mailing Address - Fax:
Practice Address - Street 1:56 PORTLAND RD STE 3
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6652
Practice Address - Country:US
Practice Address - Phone:207-604-4971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63483101YP2500X
MECC4493101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional