Provider Demographics
NPI:1295748564
Name:BIVINS, BILLIE F (LMHC, LADC II, LCPC)
Entity type:Individual
Prefix:
First Name:BILLIE
Middle Name:F
Last Name:BIVINS
Suffix:
Gender:F
Credentials:LMHC, LADC II, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 380392
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138
Mailing Address - Country:US
Mailing Address - Phone:207-985-9749
Mailing Address - Fax:
Practice Address - Street 1:111 SOUTH ST.
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143
Practice Address - Country:US
Practice Address - Phone:617-284-5130
Practice Address - Fax:617-591-0239
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL2658101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431665799Medicaid