Healthcare Provider Details

I. General information

NPI: 1285568923
Provider Name (Legal Business Name): EAST COAST COUNSELING OF MAINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CHELMAX DR
WEST BATH ME
04530-6375
US

IV. Provider business mailing address

10 CHELMAX DR
WEST BATH ME
04530-6375
US

V. Phone/Fax

Practice location:
  • Phone: 207-844-4354
  • Fax:
Mailing address:
  • Phone: 207-844-4354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: HEATHER KATHLEEN DODGE
Title or Position: CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 207-844-4354