Healthcare Provider Details

I. General information

NPI: 1295452076
Provider Name (Legal Business Name): SHALLEIGH MARIE WILLIAMS LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 ROOSEVELT TRL STE 8
NORTH WINDHAM ME
04062-5300
US

IV. Provider business mailing address

37 BIRCH DR
STANDISH ME
04084-6665
US

V. Phone/Fax

Practice location:
  • Phone: 207-300-2471
  • Fax:
Mailing address:
  • Phone: 207-396-0152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: