Provider Demographics
NPI:1588722698
Name:BELANGER, VIRGINIA E (LCPC)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:E
Last Name:BELANGER
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 1:331 KINCAID RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:ME
Mailing Address - Zip Code:04950-3923
Mailing Address - Country:US
Mailing Address - Phone:207-696-7267
Mailing Address - Fax:
Practice Address - Street 1:106 NICHOLS ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:ME
Practice Address - Zip Code:04950-1543
Practice Address - Country:US
Practice Address - Phone:207-696-7267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC1946101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431593399Medicaid