Provider Demographics
NPI:1902105497
Name:GOWDY, ANNA LOCKE (LCPC, LADC)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:LOCKE
Last Name:GOWDY
Suffix:
Gender:F
Credentials:LCPC, LADC
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:L
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:389 CONGRESS ST
Mailing Address - Street 2:ROOM 307
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3566
Mailing Address - Country:US
Mailing Address - Phone:207-874-8784
Mailing Address - Fax:207-874-8913
Practice Address - Street 1:96 FALMOUTH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-4864
Practice Address - Country:US
Practice Address - Phone:207-780-4050
Practice Address - Fax:207-807-5749
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC5248101YA0400X
MEXL3770101YP2500X
MECC4072101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)