Provider Demographics
NPI:1841651445
Name:SHEVENELL, ROGER PIERRE JR (LADC)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:PIERRE
Last Name:SHEVENELL
Suffix:JR
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:663 GRANITE ST
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-6288
Mailing Address - Country:US
Mailing Address - Phone:207-653-1169
Mailing Address - Fax:
Practice Address - Street 1:663 GRANITE ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-6288
Practice Address - Country:US
Practice Address - Phone:207-653-1169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC853101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)