Healthcare Provider Details

I. General information

NPI: 1366261356
Provider Name (Legal Business Name): MCKENSIE RIOPELL CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 RIVERSIDE DR
AUGUSTA ME
04330-8302
US

IV. Provider business mailing address

120 BOG RD
ALBION ME
04910-6227
US

V. Phone/Fax

Practice location:
  • Phone: 844-294-5306
  • Fax:
Mailing address:
  • Phone: 606-541-4945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAC8884
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: