Healthcare Provider Details

I. General information

NPI: 1255873154
Provider Name (Legal Business Name): WILLIAM CARTER LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 03/19/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 EUSTIS PKWY
WATERVILLE ME
04901-5173
US

IV. Provider business mailing address

29 FRANKLIN ST
BANGOR ME
04401-4909
US

V. Phone/Fax

Practice location:
  • Phone: 207-660-4549
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC5133
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberXL3639
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: