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General NPI Number Information
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NPI Number | 1508932963
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Entity Type | Individual
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Provider Name | LOIS C DVORAK LCPC
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Gender | Female
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6 STATE ST SUITE 610
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City | BANGOR
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State | ME
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Zip | 04401-5112
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Country | US
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Telephone | 207-947-2292
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Fax |
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Provider Business Mailing Address
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Address Line | 256 POPLAR ST
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City | OLD TOWN
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State | ME
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Zip | 04468-5905
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Country | US
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Telephone | 207-827-3087
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CC00001174
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License Number State | ME
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