Provider Demographics
NPI:1952743064
Name:MCDONNELL, HEIDI J (LCPC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:J
Last Name:MCDONNELL
Suffix:
Gender:F
Credentials:LCPC
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 1301
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:ME
Mailing Address - Zip Code:04071-1301
Mailing Address - Country:US
Mailing Address - Phone:207-518-7244
Mailing Address - Fax:
Practice Address - Street 1:1288 ROOSEVELT TRL STE 5B
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:ME
Practice Address - Zip Code:04071-6660
Practice Address - Country:US
Practice Address - Phone:207-749-3275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL3990101YP2500X
MECC4854101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional