| NPI | 1265700397 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA JADE Clinical Supervisor 207-775-0105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ME CC246) |
| Enumeration Date | 2011-12-04 |
| Last Update Date | 2011-12-04 |