Healthcare Provider Details

I. General information

NPI: 1134806680
Provider Name (Legal Business Name): SEA GLASS HEALING ARTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 CUMBERLAND ST
BRUNSWICK ME
04011-2161
US

IV. Provider business mailing address

6 CUMBERLAND ST
BRUNSWICK ME
04011-2161
US

V. Phone/Fax

Practice location:
  • Phone: 207-558-3261
  • Fax:
Mailing address:
  • Phone: 207-558-3261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: MEGHAN COLLIER
Title or Position: OWNER
Credential: LCSW, C-IAYT
Phone: 207-558-3261