Healthcare Provider Details

I. General information

NPI: 1346201233
Provider Name (Legal Business Name): LUANNE STARR RHOADES LCPC LADC CCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 04/01/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 MAIN ST
LEWISTON ME
04240-6737
US

IV. Provider business mailing address

444 MAIN ST
LEWISTON ME
04240-6737
US

V. Phone/Fax

Practice location:
  • Phone: 207-577-7071
  • Fax:
Mailing address:
  • Phone: 207-577-7071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCC2030
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLC2560
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC2030
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: