Healthcare Provider Details

I. General information

NPI: 1467364430
Provider Name (Legal Business Name): SIAELYANNA S STEPHENSON LCPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 MAIN ST
LIVERMORE FALLS ME
04254-1511
US

IV. Provider business mailing address

96 MAIN ST
LIVERMORE FALLS ME
04254-1511
US

V. Phone/Fax

Practice location:
  • Phone: 207-897-9000
  • Fax: 207-520-2373
Mailing address:
  • Phone: 207-897-9000
  • Fax: 207-520-2373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberXC9035
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: