Provider Demographics
NPI:1861803843
Name:STEVENS, GRETCHEN JANE (LCPC)
Entity type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:JANE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 MAINE STREET
Mailing Address - Street 2:SUITE #6
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011
Mailing Address - Country:US
Mailing Address - Phone:207-240-2912
Mailing Address - Fax:
Practice Address - Street 1:136 MAINE STREET
Practice Address - Street 2:SUITE #6
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011
Practice Address - Country:US
Practice Address - Phone:207-240-2912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-13
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4087101YP2500X
MECC4776101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional