Provider Demographics
NPI:1144489634
Name:DRISCOLL, MICHAEL J (LCPC, LADC, CCS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:DRISCOLL
Suffix:
Gender:M
Credentials:LCPC, LADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 PETER DANA POINT ROAD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:ME
Mailing Address - Zip Code:04668
Mailing Address - Country:US
Mailing Address - Phone:207-796-2321
Mailing Address - Fax:207-796-5154
Practice Address - Street 1:401 PETER DANA POINT ROAD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:ME
Practice Address - Zip Code:04668
Practice Address - Country:US
Practice Address - Phone:207-796-2321
Practice Address - Fax:207-796-5154
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC1308101YA0400X
MECC919101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME334750099Medicaid