Healthcare Provider Details

I. General information

NPI: 1467574574
Provider Name (Legal Business Name): LEANNE DAVIS LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 CEDAR ST
BANGOR ME
04401-6433
US

IV. Provider business mailing address

129 FOREST AVE
ORONO ME
04473-3654
US

V. Phone/Fax

Practice location:
  • Phone: 207-947-0366
  • Fax: 207-942-4350
Mailing address:
  • Phone: 207-866-7831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC1621
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: