Provider Demographics
NPI:1053778324
Name:THORN, ALEXANDER (LCPC, NCC)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:
Last Name:THORN
Suffix:
Gender:M
Credentials:LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 ROOSEVELT TRL
Mailing Address - Street 2:
Mailing Address - City:CASCO
Mailing Address - State:ME
Mailing Address - Zip Code:04015-4228
Mailing Address - Country:US
Mailing Address - Phone:207-577-0972
Mailing Address - Fax:
Practice Address - Street 1:224 ROOSEVELT TRL
Practice Address - Street 2:
Practice Address - City:CASCO
Practice Address - State:ME
Practice Address - Zip Code:04015-4228
Practice Address - Country:US
Practice Address - Phone:207-577-0972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-18
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC4918101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional