Healthcare Provider Details

I. General information

NPI: 1114674249
Provider Name (Legal Business Name): WELLNESS CENTER OF MAINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 03/08/2022
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1048 SOUTH ST
DOVER FOXCROFT ME
04426-1232
US

IV. Provider business mailing address

PO BOX 29
DOVER FOXCROFT ME
04426-0029
US

V. Phone/Fax

Practice location:
  • Phone: 207-564-3000
  • Fax: 207-422-7339
Mailing address:
  • Phone:
  • 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 Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER JAMES MCGARY
Title or Position: BUSINESS MANAGER
Credential:
Phone: 207-717-5627