Provider Demographics
NPI:1396972741
Name:FORTIER, KRISTEN L (LCPC-C, CRC)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:L
Last Name:FORTIER
Suffix:
Gender:F
Credentials:LCPC-C, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 958
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04243-0958
Mailing Address - Country:US
Mailing Address - Phone:207-333-3833
Mailing Address - Fax:207-333-6939
Practice Address - Street 1:1120 CENTER ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-6528
Practice Address - Country:US
Practice Address - Phone:207-333-3833
Practice Address - Fax:207-333-6939
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL3269101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health