Provider Demographics
NPI:1750610200
Name:WARCHOL, PHYLLIS JO (LADC)
Entity type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:JO
Last Name:WARCHOL
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:MISS
Other - First Name:PHYLLIS
Other - Middle Name:JO
Other - Last Name:KANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:159 ALBION RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-4504
Mailing Address - Country:US
Mailing Address - Phone:207-892-4179
Mailing Address - Fax:
Practice Address - Street 1:159 ALBION RD
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-4504
Practice Address - Country:US
Practice Address - Phone:207-892-4179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC3941101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)