=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467869198
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAWN LEVASSEUR, LCPC, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2014
-----------------------------------------------------
Last Update Date | 07/15/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 195 STATE ST
-----------------------------------------------------
City | BANGOR
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04401-5410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-907-4757
-----------------------------------------------------
Fax | 207-907-4757
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 195 STATE ST
-----------------------------------------------------
City | BANGOR
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04401-5410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-907-4757
-----------------------------------------------------
Fax | 207-907-4757
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DAWN LEVASSEUR
-----------------------------------------------------
Credential | LCPC
-----------------------------------------------------
Telephone | 207-907-4757
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | CC1810
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------