Healthcare Provider Details

I. General information

NPI: 1316413057
Provider Name (Legal Business Name): SEASONS OF LIFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2018
Last Update Date: 12/12/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 N BELFAST AVE
AUGUSTA ME
04330-0206
US

IV. Provider business mailing address

2821 N BELFAST AVE
AUGUSTA ME
04330-0206
US

V. Phone/Fax

Practice location:
  • Phone: 207-200-5840
  • Fax:
Mailing address:
  • Phone: 207-200-5840
  • Fax: 855-508-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. KIMBERLY ANN MORRISON
Title or Position: OWNER/EMPLOYEE
Credential: LCSW
Phone: 207-200-5840