Provider Demographics
NPI:1275693079
Name:MAILHOT, DENISE C (LADC)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:C
Last Name:MAILHOT
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 ROSEDALE ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-6133
Mailing Address - Country:US
Mailing Address - Phone:207-786-3380
Mailing Address - Fax:
Practice Address - Street 1:188 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7814
Practice Address - Country:US
Practice Address - Phone:207-513-8843
Practice Address - Fax:207-241-8318
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC4073101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431625799Medicaid