Provider Demographics
NPI:1740342591
Name:BOWDEN-SCHAIBLE, SALLY (MS, LCPC, CCMHC)
Entity type:Individual
Prefix:MS
First Name:SALLY
Middle Name:
Last Name:BOWDEN-SCHAIBLE
Suffix:
Gender:F
Credentials:MS, LCPC, CCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-2861
Mailing Address - Country:US
Mailing Address - Phone:207-856-0090
Mailing Address - Fax:207-856-0090
Practice Address - Street 1:836 MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-2861
Practice Address - Country:US
Practice Address - Phone:207-856-0090
Practice Address - Fax:207-856-0090
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC84101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME026668OtherANTHEM BCBS