Provider Demographics
NPI:1649370545
Name:DEXTER, MARIE LOUISE (CLINICAL COUNSELOR)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:LOUISE
Last Name:DEXTER
Suffix:
Gender:F
Credentials:CLINICAL COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 POND STREET
Mailing Address - Street 2:P.O. BOX 157
Mailing Address - City:RANGELELY
Mailing Address - State:ME
Mailing Address - Zip Code:04970-0157
Mailing Address - Country:US
Mailing Address - Phone:207-864-2670
Mailing Address - Fax:207-864-5600
Practice Address - Street 1:12 POND STREET
Practice Address - Street 2:
Practice Address - City:RANGELEY
Practice Address - State:ME
Practice Address - Zip Code:04970-0157
Practice Address - Country:US
Practice Address - Phone:207-864-2670
Practice Address - Fax:207-864-5600
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA169101YM0800X
MECC 3422101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health