Healthcare Provider Details

I. General information

NPI: 1841078342
Provider Name (Legal Business Name): LIFE COUNSELING MAINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 POSEIDONS CT
KENNEBUNK ME
04043-6361
US

IV. Provider business mailing address

3 POSEIDONS CT
KENNEBUNK ME
04043-6361
US

V. Phone/Fax

Practice location:
  • Phone: 207-370-9557
  • Fax:
Mailing address:
  • Phone: 207-370-9557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: AISHA E NAIMEY
Title or Position: OWNER
Credential: LCSW
Phone: 207-370-9557