Provider Demographics
NPI:1285772467
Name:SMITH, MEGAN ELIZABETH (LCPC)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:SMITH
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 1:56 HUGHES BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04444-1046
Mailing Address - Country:US
Mailing Address - Phone:207-299-7729
Mailing Address - Fax:
Practice Address - Street 1:444 STILLWATER AVE STE 104
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3500
Practice Address - Country:US
Practice Address - Phone:207-951-6493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL2650101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional