Healthcare Provider Details

I. General information

NPI: 1447185905
Provider Name (Legal Business Name): RANDEE BOULAY LCPC-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 EAST AVE
LEWISTON ME
04240-5662
US

IV. Provider business mailing address

101 EAST AVE
LEWISTON ME
04240-5662
US

V. Phone/Fax

Practice location:
  • Phone: 207-777-3399
  • Fax: 207-777-3391
Mailing address:
  • Phone: 207-777-3399
  • Fax: 207-777-3391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberXL8774
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: