Healthcare Provider Details

I. General information

NPI: 1568710044
Provider Name (Legal Business Name): NOREEN ELLEN SPRAGUE LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 01/19/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 EAST DIXFIELD RD
EAST DIXFIELD ME
04227
US

IV. Provider business mailing address

PO BOX 56
EAST DIXFIELD ME
04227-0056
US

V. Phone/Fax

Practice location:
  • Phone: 207-491-6425
  • Fax:
Mailing address:
  • Phone: 207-491-6425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberXL3950
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC4328
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: