| NPI | 1215467600 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL LYNN MCKENNA Owner 207-651-9074 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2017-06-18 |
| Last Update Date | 2020-07-10 |