Healthcare Provider Details

I. General information

NPI: 1134067234
Provider Name (Legal Business Name): DEEPER WELL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 CONIFER RDG
CUMBERLAND FORESIDE ME
04110-1700
US

IV. Provider business mailing address

35 CONIFER RDG
CUMBERLAND FORESIDE ME
04110-1700
US

V. Phone/Fax

Practice location:
  • Phone: 207-240-3912
  • Fax:
Mailing address:
  • Phone: 207-240-3912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JESSICA L CHAMBERLAIN
Title or Position: LCPC-C
Credential: CHAMBERLAIN
Phone: 207-240-3912