Provider Demographics
NPI:1679009849
Name:SAWYER, NICOLE (LCPC-CC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:SAWYER
Suffix:
Gender:F
Credentials:LCPC-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 SEWALL ST # 1
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-7116
Mailing Address - Country:US
Mailing Address - Phone:207-400-6544
Mailing Address - Fax:
Practice Address - Street 1:100 GANNETT DR # DR
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-5900
Practice Address - Country:US
Practice Address - Phone:207-845-1030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4843101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health