Healthcare Provider Details

I. General information

NPI: 1891812772
Provider Name (Legal Business Name): ANNE M LEAVER LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 06/29/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 BOYNTON ST
EASTPORT ME
04631-1204
US

IV. Provider business mailing address

17 PLEASANT ST
EASTPORT ME
04631-1631
US

V. Phone/Fax

Practice location:
  • Phone: 207-853-6001
  • Fax:
Mailing address:
  • Phone: 207-217-8620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLC4313
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC2603
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: