Provider Demographics
NPI:1740527183
Name:TOWNSEND, ALICIA M (OQMHP-C-PNMI)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:M
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:OQMHP-C-PNMI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 PALMER ST
Mailing Address - Street 2:
Mailing Address - City:CALAIS
Mailing Address - State:ME
Mailing Address - Zip Code:04619-1300
Mailing Address - Country:US
Mailing Address - Phone:207-454-0270
Mailing Address - Fax:207-454-0775
Practice Address - Street 1:127 PALMER ST
Practice Address - Street 2:
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619-1300
Practice Address - Country:US
Practice Address - Phone:207-454-0270
Practice Address - Fax:207-454-0775
Is Sole Proprietor?:No
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME010276859Medicaid