| NPI | 1013353739 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTY TISDALE Medical Director 207-786-6199 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS1000X Clinic/Center, Student Health (Licence: ME R021539) |
| Additional Taxonomies | 103T00000X Psychologist |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2013-05-21 |