Individual
MS. ANNE L KOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
778 FOREST AVENUE, PORTLAND, ME 04103
(207) 874-2884
(207) 775-3007
Mailing address
778 FOREST AVENUE, PORTLAND, ME 04103
(207) 874-2884
(207) 536-0176
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
CC1309
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
132060100
—
ME
05
—
132060101
—
ME
Enumeration date
03/23/2006
Last updated
09/13/2016
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