Provider Demographics
NPI:1679042774
Name:COGGINS, PAMELA EILEEN (LCPC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:EILEEN
Last Name:COGGINS
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 1:918 N LUBEC RD
Mailing Address - Street 2:
Mailing Address - City:LUBEC
Mailing Address - State:ME
Mailing Address - Zip Code:04652-3239
Mailing Address - Country:US
Mailing Address - Phone:207-259-0216
Mailing Address - Fax:
Practice Address - Street 1:11 MONUMENT ST
Practice Address - Street 2:
Practice Address - City:LUBEC
Practice Address - State:ME
Practice Address - Zip Code:04652-1015
Practice Address - Country:US
Practice Address - Phone:207-259-0216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC5781101YM0800X
MEXL5101101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health