Basic Information
| Provider Information | |||||||||
| NPI: | 1043453483 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DANNER | ||||||||
| FirstName: | KEITH | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | LCPCC, LADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 389 CONGRESS ST | ||||||||
| Address2: | ROOM 307 | ||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041013566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078748784 | ||||||||
| FaxNumber: | 2078748913 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 PORTLAND ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041012912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078748448 | ||||||||
| FaxNumber: | 2078748975 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2009 | ||||||||
| LastUpdateDate: | 07/29/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | LC4070 | ME | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | XL4096 | ME | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.