Healthcare Provider Details

I. General information

NPI: 1780892612
Provider Name (Legal Business Name): A CENTER FOR LIFE ENHANCEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 05/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MAPLE ST
CORNISH ME
04020-3115
US

IV. Provider business mailing address

100 MAPLE ST
CORNISH ME
04020-3115
US

V. Phone/Fax

Practice location:
  • Phone: 207-625-4525
  • Fax:
Mailing address:
  • Phone: 207-625-4525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC953
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP277
License Number StateME

VIII. Authorized Official

Name: MS. ANITA H. FLORES
Title or Position: THERAPIST
Credential: MA, CCC-SLP, LCPC
Phone: 207-625-4525