Healthcare Provider Details

I. General information

NPI: 1366261216
Provider Name (Legal Business Name): LUMI HOLISTIC HEALING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOUCHER AVE
AUGUSTA ME
04330-4307
US

IV. Provider business mailing address

1 BOUCHER AVE
AUGUSTA ME
04330-4307
US

V. Phone/Fax

Practice location:
  • Phone: 207-446-5090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LEANNE SNOWMAN
Title or Position: OWNER
Credential: LCSW
Phone: 207-446-5090