Healthcare Provider Details

I. General information

NPI: 1700238672
Provider Name (Legal Business Name): MELISSA L LEBRUN LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS MELISSA L MOREAU

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 MAIN ST
SPRINGVALE ME
04083-1870
US

IV. Provider business mailing address

PO BOX 1054
ALFRED ME
04002-1054
US

V. Phone/Fax

Practice location:
  • Phone: 207-459-4070
  • Fax:
Mailing address:
  • Phone: 207-459-4070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLC6513
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: