Provider Demographics
NPI:1154956365
Name:HOPPER, MEGHAN E (LADC CCS)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:E
Last Name:HOPPER
Suffix:
Gender:F
Credentials:LADC CCS
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:
Other - Last Name:STODDARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3031 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:ME
Mailing Address - Zip Code:04349-3001
Mailing Address - Country:US
Mailing Address - Phone:207-491-6583
Mailing Address - Fax:
Practice Address - Street 1:24 STONE ST STE 203
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:207-491-6583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC3973101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)