Provider Demographics
NPI:1396948139
Name:VANDINE, ALFRED H JR (LCPC-C)
Entity type:Individual
Prefix:
First Name:ALFRED
Middle Name:H
Last Name:VANDINE
Suffix:JR
Gender:M
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 WATER ST
Mailing Address - Street 2:
Mailing Address - City:MILLINOCKET
Mailing Address - State:ME
Mailing Address - Zip Code:04462-1534
Mailing Address - Country:US
Mailing Address - Phone:207-723-8236
Mailing Address - Fax:
Practice Address - Street 1:313 ENFIELD ROAD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457
Practice Address - Country:US
Practice Address - Phone:207-794-3554
Practice Address - Fax:207-794-3814
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL3224101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional