Provider Demographics
NPI:1306166541
Name:BOUCHER, CHERYL (LADC)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LADC
Mailing Address - Street 1:32 WINTHROP ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5624
Mailing Address - Country:US
Mailing Address - Phone:207-626-3448
Mailing Address - Fax:207-621-6228
Practice Address - Street 1:32 WINTHROP ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5624
Practice Address - Country:US
Practice Address - Phone:207-626-3448
Practice Address - Fax:207-621-6228
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME435681499Medicaid