Healthcare Provider Details

I. General information

NPI: 1831259738
Provider Name (Legal Business Name): PRISCILLA M GOSSELIN RICE LCSW, LADC, CCS, SAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 06/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HIGH ST.
SKOWHEGAN ME
04976-5173
US

IV. Provider business mailing address

67 EUSTIS PKWY
WATERVILLE ME
04901-5173
US

V. Phone/Fax

Practice location:
  • Phone: 207-474-8368
  • Fax: 207-872-4522
Mailing address:
  • Phone: 207-873-2136
  • Fax: 207-872-4522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLC1399
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC6078
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: