Healthcare Provider Details

I. General information

NPI: 1306002340
Provider Name (Legal Business Name): KATIE DICKSON LADC, CCS, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 LOCKLAND DR
WINDHAM ME
04062-5585
US

IV. Provider business mailing address

240 RUSSELL ST
LEWISTON ME
04240-4140
US

V. Phone/Fax

Practice location:
  • Phone: 207-317-6227
  • Fax:
Mailing address:
  • Phone: 207-317-6227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCC7081
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCCS5384
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLC4437
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: