Healthcare Provider Details

I. General information

NPI: 1174831481
Provider Name (Legal Business Name): KATHRYN K LAVOIE LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN LYONS

II. Dates (important events)

Enumeration Date: 09/21/2010
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FODEN ROAD - EAST SUITE 100
SOUTH PORTLAND ME
04106
US

IV. Provider business mailing address

100 GANNETT DR STE C
SOUTH PORTLAND ME
04106-5900
US

V. Phone/Fax

Practice location:
  • Phone: 207-874-1489
  • Fax:
Mailing address:
  • Phone: 207-347-2947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC4107
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: