Healthcare Provider Details

I. General information

NPI: 1255830998
Provider Name (Legal Business Name): SHANNON CHARETTE LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2018
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 CENTRAL ST STE 1
MILLINOCKET ME
04462-2108
US

IV. Provider business mailing address

PO BOX 134
MILLINOCKET ME
04462-0134
US

V. Phone/Fax

Practice location:
  • Phone: 207-261-2104
  • Fax: 207-261-2102
Mailing address:
  • Phone: 207-261-2104
  • Fax: 207-261-2102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCC6832
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: