Healthcare Provider Details

I. General information

NPI: 1316052616
Provider Name (Legal Business Name): DOROTHY CALDWELL LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DOROTHY CALDWELL LCPC

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 US HWY ONE SUITE 4
VERONA ISLAND ME
04416-1881
US

IV. Provider business mailing address

PO BOX 1881
BUCKSPORT ME
04416-1881
US

V. Phone/Fax

Practice location:
  • Phone: 207-469-1013
  • Fax:
Mailing address:
  • Phone: 207-469-1013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC1986
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: