Healthcare Provider Details

I. General information

NPI: 1609238450
Provider Name (Legal Business Name): JULIE ANN DAIGNAULT L.A.D.C., C.C.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 TANDBERG TRL
WINDHAM ME
04062-5841
US

IV. Provider business mailing address

86 TANDBERG TRL
WINDHAM ME
04062-5841
US

V. Phone/Fax

Practice location:
  • Phone: 207-893-0386
  • Fax: 207-893-2086
Mailing address:
  • Phone: 207-893-0386
  • Fax: 207-893-2086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLC5089
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCCS5541
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: