Provider Demographics
NPI:1740418250
Name:HEIDI M. PLOURDE, LCPC INC.
Entity type:Organization
Organization Name:HEIDI M. PLOURDE, LCPC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PLOURDE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:207-478-0566
Mailing Address - Street 1:17 S TIERY ST
Mailing Address - Street 2:
Mailing Address - City:OLD TOWN
Mailing Address - State:ME
Mailing Address - Zip Code:04468-1830
Mailing Address - Country:US
Mailing Address - Phone:207-478-0566
Mailing Address - Fax:
Practice Address - Street 1:263 MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CORINTH
Practice Address - State:ME
Practice Address - Zip Code:04427-3023
Practice Address - Country:US
Practice Address - Phone:207-478-0566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC3186101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432863700Medicaid