Provider Demographics
NPI:1083885743
Name:GERVAIS, PAUL GERVAIS (PHD, LCPC, LPC, LMFT)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:GERVAIS
Last Name:GERVAIS
Suffix:
Gender:M
Credentials:PHD, LCPC, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 JULIANNE LN
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-6251
Mailing Address - Country:US
Mailing Address - Phone:207-622-0713
Mailing Address - Fax:
Practice Address - Street 1:16 JULIANNE LN
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-6251
Practice Address - Country:US
Practice Address - Phone:207-622-0713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC231, PC212, MF214101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health