Provider Demographics
NPI:1295794139
Name:PRICHARD, DAVID C (PHD, LCPC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:PRICHARD
Suffix:
Gender:M
Credentials:PHD, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 ASHMONT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3002
Mailing Address - Country:US
Mailing Address - Phone:207-272-8841
Mailing Address - Fax:207-221-4719
Practice Address - Street 1:491 STEVENS AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2636
Practice Address - Country:US
Practice Address - Phone:207-272-8841
Practice Address - Fax:207-221-4719
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME00795101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432079899Medicaid