Provider Demographics
NPI:1063888675
Name:GROTTON PELLETIER, KAREN LEE (LCPCC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:LEE
Last Name:GROTTON PELLETIER
Suffix:
Gender:F
Credentials:LCPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 NORTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04444-1811
Mailing Address - Country:US
Mailing Address - Phone:207-478-3376
Mailing Address - Fax:
Practice Address - Street 1:499 BROADWAY
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3460
Practice Address - Country:US
Practice Address - Phone:207-478-3376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4515101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health