Provider Demographics
NPI:1144993809
Name:STACKPOLE, CARRIE (LADC, CCS)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:STACKPOLE
Suffix:
Gender:F
Credentials:LADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 KENNEBEC ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04937-3460
Mailing Address - Country:US
Mailing Address - Phone:207-877-4381
Mailing Address - Fax:
Practice Address - Street 1:64 KENNEBEC ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:ME
Practice Address - Zip Code:04937-3460
Practice Address - Country:US
Practice Address - Phone:207-877-4381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MELC7985101YA0400X
MECCS8505101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)