Provider Demographics
NPI:1124243795
Name:FLEWELLING, LOIS M (LCPC)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:M
Last Name:FLEWELLING
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1511
Mailing Address - Street 2:
Mailing Address - City:HOULTON
Mailing Address - State:ME
Mailing Address - Zip Code:04730-5511
Mailing Address - Country:US
Mailing Address - Phone:207-532-9906
Mailing Address - Fax:207-521-0900
Practice Address - Street 1:144 MILITARY ST
Practice Address - Street 2:
Practice Address - City:HOULTON
Practice Address - State:ME
Practice Address - Zip Code:04730-2508
Practice Address - Country:US
Practice Address - Phone:207-532-9906
Practice Address - Fax:207-521-0900
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC3013101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME245470099Medicaid