Healthcare Provider Details

I. General information

NPI: 1396264933
Provider Name (Legal Business Name): COUNSELING AND TRAUMA THERAPY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 ALFRED ST
BIDDEFORD ME
04005-3102
US

IV. Provider business mailing address

314 ALFRED ST
BIDDEFORD ME
04005-3102
US

V. Phone/Fax

Practice location:
  • Phone: 207-216-2637
  • Fax:
Mailing address:
  • Phone: 207-216-2637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC16712
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: WAYNE COLBY WILLIAMS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: LCSW
Phone: 207-216-2637