Healthcare Provider Details

I. General information

NPI: 1790551414
Provider Name (Legal Business Name): WILLIAM JOHN LAFFAN LCPC-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: WILLIAM JOHN ANDERSON

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 LANCASTER ST
PORTLAND ME
04101-2406
US

IV. Provider business mailing address

165 LANCASTER ST
PORTLAND ME
04101-2406
US

V. Phone/Fax

Practice location:
  • Phone: 207-874-1030
  • Fax: 207-874-1044
Mailing address:
  • Phone: 207-874-1030
  • Fax: 207-874-1044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberXL6897
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberXL6897
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: