Provider Demographics
NPI:1154915544
Name:DUBAR, EMILI MARIE (LSX, LCPC-C)
Entity type:Individual
Prefix:
First Name:EMILI
Middle Name:MARIE
Last Name:DUBAR
Suffix:
Gender:F
Credentials:LSX, LCPC-C
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 194
Mailing Address - Street 2:
Mailing Address - City:WOOLWICH
Mailing Address - State:ME
Mailing Address - Zip Code:04579-0194
Mailing Address - Country:US
Mailing Address - Phone:207-350-9777
Mailing Address - Fax:
Practice Address - Street 1:24 STONE ST STE 201
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5209
Practice Address - Country:US
Practice Address - Phone:207-974-6780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELSX19099104100000X
MEXL5563101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker