Healthcare Provider Details

I. General information

NPI: 1730398553
Provider Name (Legal Business Name): DONNA J LIGHT LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 FIELD ST SUITE 206
BELFAST ME
04915
US

IV. Provider business mailing address

16 TAPESTRY GARDENS LN
SEARSMONT ME
04973-3200
US

V. Phone/Fax

Practice location:
  • Phone: 207-338-2022
  • Fax: 207-338-9922
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLC3319
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: