Individual
EMILY E ELLIOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC-C
Contact information
Practice address
165 LANCASTER ST, PORTLAND, ME 04101-2406
(207) 874-1030
Mailing address
78 ATLANTIC PL, SOUTH PORTLAND, ME 04106-2316
(207) 842-6540
(207) 842-7773
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
XL3603
ME
101YA0400X
Addiction (Substance Use Disorder) Counselor
LC4159
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
435433099
—
ME
Enumeration date
01/15/2010
Last updated
06/17/2011
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