1518977891 NPI number — MICHELLE MCCOMB LCPC

Table of content: MICHELLE MCCOMB LCPC (NPI 1518977891)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518977891 NPI number — MICHELLE MCCOMB LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCOMB
Provider First Name:
MICHELLE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518977891
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35 WESTERN AVE
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
KENNEBUNK
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04043-7366
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-432-4757
Provider Business Mailing Address Fax Number:
207-204-1400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 WESTERN AVE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
KENNEBUNK
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04043-7366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-432-4757
Provider Business Practice Location Address Fax Number:
207-204-1400
Provider Enumeration Date:
08/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  CC3311 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 431958399 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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