Healthcare Provider Details

I. General information

NPI: 1033876453
Provider Name (Legal Business Name): MICHELLE AYOTTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 RIVERSIDE DR STE 1
AUGUSTA ME
04330-4100
US

IV. Provider business mailing address

147 RIVERSIDE DR STE 1
AUGUSTA ME
04330-4100
US

V. Phone/Fax

Practice location:
  • Phone: 833-356-4080
  • Fax:
Mailing address:
  • Phone: 833-356-4080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: