Healthcare Provider Details

I. General information

NPI: 1689199630
Provider Name (Legal Business Name): PETER D. VIGUE LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 HIGH ST STE 525
PORTLAND ME
04101-2851
US

IV. Provider business mailing address

142 HIGH STREET SUITE 525
PORTLAND ME
04101
US

V. Phone/Fax

Practice location:
  • Phone: 207-318-7502
  • Fax:
Mailing address:
  • Phone: 207-318-7502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC4475
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: