Healthcare Provider Details

I. General information

NPI: 1154915544
Provider Name (Legal Business Name): EMILI MARIE DUBAR LSX, LCPC-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2021
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 STONE ST STE 201
AUGUSTA ME
04330-5209
US

IV. Provider business mailing address

PO BOX 194
WOOLWICH ME
04579-0194
US

V. Phone/Fax

Practice location:
  • Phone: 207-974-6780
  • Fax:
Mailing address:
  • Phone: 207-350-9777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberXL5563
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSX19099
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: