Provider Demographics
NPI:1215655931
Name:FOUGERE, SUZANNE VICTORIA (LCPC-C)
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:VICTORIA
Last Name:FOUGERE
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6508
Mailing Address - Country:US
Mailing Address - Phone:207-659-4763
Mailing Address - Fax:
Practice Address - Street 1:67 ACME RD
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1524
Practice Address - Country:US
Practice Address - Phone:207-991-5200
Practice Address - Fax:207-989-2109
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL6695101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health