Healthcare Provider Details

I. General information

NPI: 1669790945
Provider Name (Legal Business Name): MARIA POUSSON LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2010
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 MAIN ST
NORWAY ME
04268-5643
US

IV. Provider business mailing address

180 MAIN ST
NORWAY ME
04268-5643
US

V. Phone/Fax

Practice location:
  • Phone: 207-520-3262
  • Fax:
Mailing address:
  • Phone: 207-520-3262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCC4255
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: