Provider Demographics
NPI:1356021018
Name:WALLINGFORD, MORGAN (LCPC)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:WALLINGFORD
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 1:201 MAIN ST STE 4B
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-4763
Mailing Address - Country:US
Mailing Address - Phone:207-579-9882
Mailing Address - Fax:207-579-9876
Practice Address - Street 1:201 MAIN ST STE 4B
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4763
Practice Address - Country:US
Practice Address - Phone:207-579-9882
Practice Address - Fax:207-579-9876
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC7551101Y00000X, 101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MECC7551OtherME LICENSE