| NPI | 1760744601 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLEN DAVIS Psychologist 207-221-2631 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: ME PS593) |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2022-02-22 |