Healthcare Provider Details

I. General information

NPI: 1730282856
Provider Name (Legal Business Name): GRETCHEN FALL LCPC, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRETCHEN FALL SAWYER LCPC, CADC

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 MAIN ST COMMON GROUND COUNSELING
NORWAY ME
04268-5943
US

IV. Provider business mailing address

PO BOX 904
BETHEL ME
04217
US

V. Phone/Fax

Practice location:
  • Phone: 207-739-2644
  • Fax:
Mailing address:
  • Phone: 207-595-4564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC3327
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: