| NPI | 1568120111 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS C DUREPO Psychotherapist/Manager 207-492-0903 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2021-12-01 |
| Last Update Date | 2021-12-01 |