Healthcare Provider Details

I. General information

NPI: 1346611860
Provider Name (Legal Business Name): LISA M CUSHING CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2015
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 PALMER ST
CALAIS ME
04619-1300
US

IV. Provider business mailing address

43 HATCH DR SUITE 210
CARIBOU ME
04736-2161
US

V. Phone/Fax

Practice location:
  • Phone: 207-498-6431
  • Fax:
Mailing address:
  • Phone: 207-498-6431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAC3653
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: