Healthcare Provider Details

I. General information

NPI: 1710494315
Provider Name (Legal Business Name): LACEY MARIE GRAFFAM M.S., LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2018
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 RANGE E RD
LIMERICK ME
04048-4226
US

IV. Provider business mailing address

175 DEER CROSSING RD
LIMERICK ME
04048-3418
US

V. Phone/Fax

Practice location:
  • Phone: 207-432-4007
  • Fax:
Mailing address:
  • Phone: 207-432-4007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCC6373
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: