Provider Demographics
NPI:1811057847
Name:COOLEY, ANITA LOUISE (LCSW, LADC)
Entity type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:LOUISE
Last Name:COOLEY
Suffix:
Gender:F
Credentials:LCSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:897 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-1029
Mailing Address - Country:US
Mailing Address - Phone:207-564-4276
Mailing Address - Fax:207-564-4478
Practice Address - Street 1:69 HIGH ST
Practice Address - Street 2:
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-1270
Practice Address - Country:US
Practice Address - Phone:207-564-4276
Practice Address - Fax:207-564-4478
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC4122101YA0400X
MELC117611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)