Healthcare Provider Details

I. General information

NPI: 1689020695
Provider Name (Legal Business Name): ELIZABETH ANN POLLOCK CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2016
Last Update Date: 08/30/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 BEECH ST
CALAIS ME
04619-1203
US

IV. Provider business mailing address

9 MAIN ST SUITE D PO BOX 175
LINCOLN ME
04457
US

V. Phone/Fax

Practice location:
  • Phone: 207-454-1300
  • Fax: 207-454-1332
Mailing address:
  • Phone: 207-521-8911
  • Fax: 207-454-1332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: