Provider Demographics
NPI:1962796003
Name:SMITH, JULIE ANNE (LADC)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LADC
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 384
Mailing Address - Street 2:
Mailing Address - City:BROOKS
Mailing Address - State:ME
Mailing Address - Zip Code:04921-0384
Mailing Address - Country:US
Mailing Address - Phone:207-212-9566
Mailing Address - Fax:
Practice Address - Street 1:243 HIGH ST
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6603
Practice Address - Country:US
Practice Address - Phone:207-735-6370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC4647101YA0400X
MELC5447101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)