Provider Demographics
NPI:1912149873
Name:NICHOLAS, LINDA MAE (LCPC/LADC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MAE
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:LCPC/LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 351
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:ME
Mailing Address - Zip Code:04667-0351
Mailing Address - Country:US
Mailing Address - Phone:207-853-0644
Mailing Address - Fax:207-853-2347
Practice Address - Street 1:11 BACK RD
Practice Address - Street 2:
Practice Address - City:PLEASANT POINT
Practice Address - State:ME
Practice Address - Zip Code:04667-4119
Practice Address - Country:US
Practice Address - Phone:207-853-0644
Practice Address - Fax:207-853-2347
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC1748101YP2500X
MELC3080101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)