Healthcare Provider Details

I. General information

NPI: 1407232895
Provider Name (Legal Business Name): JOSHUA A DYER LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2015
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 EUSTIS PKWY
WATERVILLE ME
04901-5173
US

IV. Provider business mailing address

67 EUSTIS PKWY
WATERVILLE ME
04901-5173
US

V. Phone/Fax

Practice location:
  • Phone: 207-660-4549
  • Fax: 207-660-4529
Mailing address:
  • Phone: 207-660-4549
  • Fax: 207-660-4529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC5838
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: