| NPI | 1942075551 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAYLA BROOKE OUELLETTELCSW Clinical Social Worker 207-713-9123 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2023-11-24 |
| Last Update Date | 2023-11-24 |