Healthcare Provider Details

I. General information

NPI: 1053248740
Provider Name (Legal Business Name): AUDRA ELIZABETH YOUNG WARREN LCPC-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

869 MAIN ST STE 1000
WESTBROOK ME
04092-2867
US

IV. Provider business mailing address

656 JELLERSON RD
EAST WATERBORO ME
04030-5223
US

V. Phone/Fax

Practice location:
  • Phone: 207-806-8923
  • Fax:
Mailing address:
  • Phone: 207-806-8923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberXL8619
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: