Provider Demographics
NPI:1154956043
Name:PISKURA, JOAN (CADC)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:PISKURA
Suffix:
Gender:F
Credentials:CADC
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 364
Mailing Address - Street 2:
Mailing Address - City:ORLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04472-0364
Mailing Address - Country:US
Mailing Address - Phone:207-610-9442
Mailing Address - Fax:
Practice Address - Street 1:70 KINGSLAND XING STE A
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-2570
Practice Address - Country:US
Practice Address - Phone:207-835-5809
Practice Address - Fax:207-835-5809
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC6349101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)