Healthcare Provider Details

I. General information

NPI: 1275693079
Provider Name (Legal Business Name): DENISE C MAILHOT LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 LINCOLN ST
LEWISTON ME
04240-7814
US

IV. Provider business mailing address

67 ROSEDALE ST
LEWISTON ME
04240-6133
US

V. Phone/Fax

Practice location:
  • Phone: 207-513-8843
  • Fax: 207-241-8318
Mailing address:
  • Phone: 207-786-3380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLC4073
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: