Individual
CAROL MAYNARD LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC, CADC
Contact information
Practice address
12 WESTBROOK CMN, WESTBROOK, ME 04092-2819
(207) 856-1500
(207) 856-1518
Mailing address
78 ATLANTIC PL, SOUTH PORTLAND, ME 04106-2316
(207) 661-6654
(207) 842-7773
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CAC3744
ME
101YP2500X
Professional Counselor
Primary
CC2507
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
432159799
—
ME
Enumeration date
08/25/2006
Last updated
07/14/2016
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