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NEXT STEP DOMESTIC VIOLENCE PROJECT

Ambulatory Health Care Facilities Clinic/Center Mental Health (Including Community Mental Health Center)

Provider NPI: 1073037099

Organization Information:
Organization Name:  NEXT STEP DOMESTIC VIOLENCE PROJECT
Organization is not Subpart
Authorized Official:  DORATHY  MARTELL  EXECUTIVE DIRECTOR  207-667-0176

Practice Location:
733 BANGOR RD  ELLSWORTH, ME 04605-3580 US
Tel: 207-667-0176  Fax: 207-667-8033

Business Mailing Address:
PO BOX 1466  ELLSWORTH, ME 04605-1466 US
Tel: 207-667-0176  Fax: 207-667-8033

NPI Information:
NPI: 1073037099
Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y261QM0801XAmbulatory Health Care Facilities
Clinic/Center
Mental Health (Including Community Mental Health Center)
MEXL-4560

Other Provider Identifiers:

IssuerNumberStateType
LCPC-C LICENSE NUMBERXL-4560ME01



American Medical Association 2012 taxonomy code information

Code: 261QM0801X

Type:

Classification:



Definition:



MEDICAL JOBS ME - Page 1

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