Healthcare Provider Details

I. General information

NPI: 1689880643
Provider Name (Legal Business Name): CATHERINE CHARETTE LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
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

89 BUGBEE RD
DEXTER ME
04930-2421
US

V. Phone/Fax

Practice location:
  • Phone: 207-947-0366
  • Fax: 207-947-2825
Mailing address:
  • Phone: 207-947-0366
  • Fax: 207-947-2825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC1916
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: