Provider Demographics
NPI:1952782369
Name:VENABLE, JEFFREY D (LCPC, LADC, CCS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:D
Last Name:VENABLE
Suffix:
Gender:M
Credentials:LCPC, LADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 COURT ST STE 204
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-6917
Mailing Address - Country:US
Mailing Address - Phone:530-746-8018
Mailing Address - Fax:
Practice Address - Street 1:178 COURT ST STE 204
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-6917
Practice Address - Country:US
Practice Address - Phone:530-746-8018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC5747101YA0400X
MECC5131101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)