Provider Demographics
NPI:1992112676
Name:TEMPLE, GINA D (LCPC-C)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:D
Last Name:TEMPLE
Suffix:
Gender:F
Credentials:LCPC-C
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 1018
Mailing Address - Street 2:
Mailing Address - City:RANGELEY
Mailing Address - State:ME
Mailing Address - Zip Code:04970-1018
Mailing Address - Country:US
Mailing Address - Phone:207-841-4315
Mailing Address - Fax:
Practice Address - Street 1:42 DALLAS HILL RD
Practice Address - Street 2:
Practice Address - City:RANGELEY
Practice Address - State:ME
Practice Address - Zip Code:04970-4032
Practice Address - Country:US
Practice Address - Phone:207-841-4315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL3859101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional