Lisa M Wing, LCPC-C
Individual provider Active NPI Professional Counselor · Northport, ME
NPI 1053781336 · NPPES record last updated Nov 11, 2024
Key facts
- NPI
- 1053781336
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- XL4577 (ME)
- Practice address
- 12 Eagle Dr
Northport, ME 04849-3253 - Phone
- (207) 631-7626
- NPI assigned
- Sep 30, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ME
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240502002894 | ME | Practitioner - Mental Health Counselor | 2769822089 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| XL4577 | ME | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Best Life Counseling LLC | Current |
Accepting new patients | |
| Sweetser | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | XL4577 | ME | Yes |
Addresses
Primary practice location
12 Eagle Dr
Northport, ME 04849-3253
Mailing address
12 Eagle Dr
Northport, ME 04849-3253
Phone (207) 631-7626
Other providers in Northport, ME
- Seablue Physical Therapy LLC
- Susan Shershow
- William M Strassberg
- Victoria L. Matthews, D.D.S., P.a.
- Jennifer Ann Wenz
- Karen J Young
All providers in Northport, ME · Professional Counselor in Maine
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 11, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.