| NPI | 1508936196 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLA KINGSTON Administrator 207-773-2828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2012-10-25 |