Provider Demographics
NPI:1427214766
Name:DEWITT, RUTH A (LCPC, LADC)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:A
Last Name:DEWITT
Suffix:
Gender:F
Credentials:LCPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 LISBON ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7198
Mailing Address - Country:US
Mailing Address - Phone:207-783-4268
Mailing Address - Fax:
Practice Address - Street 1:11 LISBON ST
Practice Address - Street 2:SUITE 105
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7198
Practice Address - Country:US
Practice Address - Phone:207-783-4268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC263101YA0400X
MECC1855101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)