Individual
MR. GERALD W. THIBAULT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCPC
Contact information
Practice address
157 WATERVILLE ROAD, SUITE 2, SKOWHEGAN, ME 04976
(207) 474-3477
Mailing address
27 BEECH STREET, SKOWHEGAN, ME 04976
(207) 474-3477
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
CC1829
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
274710099
—
ME
Enumeration date
11/22/2005
Last updated
06/25/2009
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