Provider Demographics
NPI:1689020695
Name:POLLOCK, ELIZABETH ANN (CADC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:POLLOCK
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MAIN ST
Mailing Address - Street 2:SUITE D PO BOX 175
Mailing Address - City:LINCOLN
Mailing Address - State:ME
Mailing Address - Zip Code:04457
Mailing Address - Country:US
Mailing Address - Phone:207-521-8911
Mailing Address - Fax:207-454-1332
Practice Address - Street 1:12 BEECH ST
Practice Address - Street 2:
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619-1203
Practice Address - Country:US
Practice Address - Phone:207-454-1300
Practice Address - Fax:207-454-1332
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1689020695Medicaid