Healthcare Provider Details

I. General information

NPI: 1174449466
Provider Name (Legal Business Name): GINA KRAWIETZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 ENFIELD RD
LINCOLN ME
04457-1190
US

IV. Provider business mailing address

26 LIBBY ST
LINCOLN ME
04457-1611
US

V. Phone/Fax

Practice location:
  • Phone: 207-403-9197
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberXL8365
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: