Healthcare Provider Details

I. General information

NPI: 1487564571
Provider Name (Legal Business Name): ANNA VERONICA SMITH LCPC-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 CENTER ST
BREWER ME
04412-1961
US

IV. Provider business mailing address

54 FOREST AVE APT 1
ORONO ME
04473-3648
US

V. Phone/Fax

Practice location:
  • Phone: 207-561-9496
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberXL9019
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: