Individual
CLIFFORD THIBODEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC, CCS
Contact information
Practice address
65 INDIA ST, PORTLAND, ME 04101-4209
(207) 775-4790
(207) 775-5231
Mailing address
65 INDIA ST, PORTLAND, ME 04101-4209
(207) 775-4790
(207) 775-5231
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LC3438
ME
Other
Enumeration date
04/02/2013
Last updated
04/02/2013
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