Provider Demographics
NPI:1265733208
Name:JADE, LISA DEHAHN (LCPC, LADC, CCS)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:DEHAHN
Last Name:JADE
Suffix:
Gender:
Credentials:LCPC, LADC, CCS
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:J
Other - Last Name:DEHAHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:78 ATLANTIC PL
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2316
Mailing Address - Country:US
Mailing Address - Phone:207-661-6654
Mailing Address - Fax:207-842-7773
Practice Address - Street 1:66 BARIBEAU DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3230
Practice Address - Country:US
Practice Address - Phone:207-373-6991
Practice Address - Fax:207-373-6080
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC3707101YA0400X
MECC2672101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)