Provider Demographics
NPI:1982115481
Name:PELLETIER, ABIGAIL (MHRT-C, CADC)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:MHRT-C, CADC
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 1018
Mailing Address - Street 2:
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-1018
Mailing Address - Country:US
Mailing Address - Phone:207-498-6431
Mailing Address - Fax:
Practice Address - Street 1:43 HATCH DR
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-2161
Practice Address - Country:US
Practice Address - Phone:207-498-6431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC6447101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME010276859Medicaid