Healthcare Provider Details

I. General information

NPI: 1770303364
Provider Name (Legal Business Name): ADRIENNE CHANDLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 STONE ST
AUGUSTA ME
04330-5227
US

IV. Provider business mailing address

18 WARREN ST APT 5
HALLOWELL ME
04347-1227
US

V. Phone/Fax

Practice location:
  • Phone: 888-322-2136
  • Fax:
Mailing address:
  • Phone: 207-779-7759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberXL7764
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: