Provider Demographics
NPI:1427757095
Name:ODONNELL, DAVID COLEMAN (LCPCC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:COLEMAN
Last Name:ODONNELL
Suffix:
Gender:M
Credentials:LCPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 270
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE FALLS
Mailing Address - State:ME
Mailing Address - Zip Code:04254-0270
Mailing Address - Country:US
Mailing Address - Phone:207-897-9000
Mailing Address - Fax:207-520-2373
Practice Address - Street 1:96 MAIN ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE FALLS
Practice Address - State:ME
Practice Address - Zip Code:04254-1511
Practice Address - Country:US
Practice Address - Phone:207-897-9000
Practice Address - Fax:207-520-2373
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL7013101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional